piperidines and Laryngeal-Diseases

The aim of this study was to discover the optimal effect-site concentration of remifentanil for cough prevention that does not delay awakening or cause respiratory depression during emergence from anesthesia with propofol and remifentanil in laryngomicrosurgery patients.. Prospective, randomized, controlled trial.. One hundred five patients were randomly assigned to maintain an effect-site concentration (Ce) of remifentanil at a predetermined value of 1 (R1), 1.5 (R1.5), and 2 (R2) ng/mL during emergence. The incidence and grade (0, no coughing; 1, single cough; 2, more than one episode of nonsustained coughing; 3, sustained and repetitive coughing with head lift) of cough, emergence time, blood pressure (MAP), heart rate (HR), spontaneous respiratory rate, oxygen saturation, and postoperative nausea and vomiting (PONV) were recorded during emergence and recovery.. The total number of patients with coughing during emergence was lower in groups R1.5 and R2 than in group R1. The cough grade during tracheal extubation was lower in groups R1.5 and R2 than in group R1. In group R2, emergence time was longer and postanesthesia care unit score was lower than in groups R1 and R1.5. Also in group R2, transient hypoventilation and PONV were more frequent compared to group R1. There were no differences in MAP and HR among the three groups during emergence and recovery.. Maintenance of remifentanil at Ce 1.5 and 2 ng/mL suppressed coughing without serious adverse events during emergence from anesthesia with propofol and remifentanil in patients undergoing laryngomicrosurgery.

Topics: Adult; Aged; Cough; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Hypnotics and Sedatives; Injections, Intravenous; Laryngeal Diseases; Larynx; Male; Microsurgery; Middle Aged; Piperidines; Postoperative Complications; Prospective Studies; Remifentanil; Treatment Outcome; Young Adult

Maintaining spontaneous ventilation (SV) under total intravenous anesthesia (TIVA) without an endotracheal tube provides uninterrupted and unobstructed surgical access for suspension microlaryngoscopy (SML). This study describes the method and outcome of adults who underwent SML under tubeless TIVA-SV.. Retrospective review of adults who underwent SML between June 2014 and September 2016 using TIVA-SV without an endotracheal tube.. Sixty-six cases in 36 patients were included with mean age of 50.6 years and 52.7% were female. Airway pathology included 41.6% subglottic or tracheal stenosis, 19.4% laryngeal lesion or mass, 16.7% glottic stenosis, 13.9% recurrent respiratory papilloma, and 8.3% supraglottic stenosis. Anesthesia was most commonly provided by continuous infusion of propofol and remifentanil (57.6%). Approximately half (53%) of cases received superior laryngeal nerve block. Average operative time was 72.9 minutes (range, 27-166 minutes). Eight cases required supplemental ventilation: 6 cases required transient endotracheal ventilation or mask ventilation, and 2 cases were converted to alternative ventilation.. Total intravenous anesthesia is an attractive alternative to traditional endotracheal tube intubation, jet ventilation, or intermittent apneic ventilation for adult SML. During episodes of hypoventilation or desaturation, endotracheal ventilation, mask ventilation, or jet ventilation can effectively recover oxygenation.

Topics: Adult; Aged; Anesthesia, Intravenous; Anesthetics, Intravenous; Female; Humans; Intubation, Intratracheal; Laryngeal Diseases; Laryngoscopes; Laryngoscopy; Male; Middle Aged; Miniaturization; Operative Time; Piperidines; Remifentanil; Respiration; Retrospective Studies; Tracheal Stenosis; Treatment Outcome

We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance.

Topics: Anesthetics, Local; Dyspnea; Female; Fiber Optic Technology; Hoarseness; Humans; Intubation, Intratracheal; Laryngeal Diseases; Laryngoscopy; Middle Aged; Piperidines; Polyps; Remifentanil; Treatment Outcome; Vocal Cords