51
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Casals P, Cochs J, Mayoral V, Rey F, Drudis R, Canales MA. [The Combitube as an alternative method when intubation is impossible]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 1994; 41:189-90. [PMID: 8059051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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52
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Grillone GA, Blitzer A, Brin MF, Annino DJ, Saint-Hilaire MH. Treatment of adductor laryngeal breathing dystonia with botulinum toxin type A. Laryngoscope 1994; 104:30-2. [PMID: 8295454 DOI: 10.1288/00005537-199401000-00007] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Adductor laryngeal breathing dystonia (ALBD) is a rare disorder in which patients have persistent inspiratory stridor, usually normal voice, and cough. Physical exam is characterized by paradoxical movement of the vocal cords on inspiration. These patients have involuntary action-induced spasms of the adductor laryngeal muscles on inspiration. There has been no uniformly satisfactory treatment for the disease. Speech therapy, psychotherapy, and pharmacotherapy have all had limited success. We report the successful use of botulinum toxin type A in seven patients with adductor laryngeal breathing dystonia. All patients received bilateral thyroarytenoid injections. All patients had toxin effect within 72 hours, reaching maximal effect within 2 weeks with sustained improvement for an average of 13.8 weeks. Adverse effects included breathy voice and mild choking on liquids. Both resolved, on average, within 2 weeks. This retrospective study supports the safe and effective use of botulinum toxin type A in the treatment of adductor laryngeal breathing dystonia.
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53
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Forbes R, Layman A. Review reviewed. Anesth Analg 1994; 78:191-2. [PMID: 8267164 DOI: 10.1213/00000539-199401000-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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54
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Witsell DL, Weissler MC, Donovan MK, Howard JF, Martinkosky SJ. Measurement of laryngeal resistance in the evaluation of botulinum toxin injection for treatment of focal laryngeal dystonia. Laryngoscope 1994; 104:8-11. [PMID: 8295461 DOI: 10.1288/00005537-199401000-00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In the past, there has been no consistent, objective method of following patients undergoing botulinum toxin injections for treatment of laryngeal dystonia. Herein, the application of translaryngeal resistance measurements to 15 dysphonic patients is described. Laryngeal resistance is calculated from analysis of translaryngeal pressure and airflow during the utterance /pi/, and found to fall predictably after successful toxin injection. In our series of patients, laryngeal resistance dropped by 69.1% after initial toxin injection. The changes in resistance over time correlate with subjective impressions of voice quality. Translaryngeal resistance measurements can be used objectively to follow patients longitudinally after injection and to collect objective data for analysis. No previously described measurements have met all these criteria. Laryngeal resistance measurement is an ideal method of documenting the results of botulinum toxin injection for the treatment of focal laryngeal dystonia.
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55
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Halow KD, Ford EG. Pulmonary edema following post-operative laryngospasm: a case report and review of the literature. Am Surg 1993; 59:443-7. [PMID: 8323077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The pathophysiology of acute, negative-pressure pulmonary edema following post-anesthetic laryngospasm (PLPE) is unclear. We present a patient and review the literature to propose etiology and management. Nineteen reported patients (3 female, 16 male, aged 3 months to 60 years) with PLPE had undergone 10 otolaryngologic, three orthopedic, four skin/soft tissue, one intraabdominal, and one ophthalmologic procedures. Twelve patients (63%) had significant medical history. Initial intubation was performed without difficulty in 17 patients, there were no predisposing trends in anesthetic management, and post-anesthetic extubation was performed without difficulty in 18 patients. Thirteen patients developed laryngospasm in less than 2 minutes. Eight were ventilated with bag/mask, 15 required reintubation, and nine required paralysis. Onset of PLPE was less than 3 minutes in 12 patients; chest roentgenograms showed edema in 17 patients. Mechanical ventilation was required for less than 24 hours in all patients. PLPE cleared in less than 24 hours in most patients. Furosemide was administered in nine patients, digoxin in one, theophylline in two, and steroids in four patients. The precise pathophysiologic mechanism of PLPE is unclear despite numerous proposed mechanisms. PLPE resolves rapidly with short-term ventilatory support. Use of diuretics/airway dilators is variable, and their contribution to management is unclear.
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Abstract
A 49-year-old man presented with a two-day history of severe recurrent dyspnea and inspiratory stridor. A chest roentgenogram, computed tomographic scan of the neck, direct laryngoscopy, and bronchoscopy excluded organic upper airway obstruction. Laryngospasm occurred during the bronchoscopy. Although flow volume loops revealed severe upper airway obstruction (inspiratory and expiratory), airway resistance measured plethysmographically (during panting) was normal. Because of this observation, panting was recommended for relief of the patient's recurrent attacks of functional laryngeal obstruction. The panting maneuver immediately and completely relieved all 25 to 30 subsequent attacks. After the patient recovered clinically, a flow volume loop was repeated and was found to be normal. The marked discrepancy between severe flow limitation (as detected by flow volume loops) and normal airway resistance (measured plethysmographically) may be a diagnostic test for functional laryngeal obstruction, and panting may be an effective emergency measure for its relief. Relief by panting may also suggest the diagnosis. A second patient with an almost identical symptom complex is described, in whom the panting maneuver was also dramatically successful in promptly aborting recurrent severe attacks of airway obstruction and stridor.
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Abstract
Pulmonary edema secondary to postextubation laryngospasm is a potentially life-threatening problem, demanding early diagnosis and prompt treatment. We believe that this problem has been grossly underestimated in its incidence, as only seven adults have been reported in the English literature, whereas seven adults have been observed at our institution in only a 24 month period. All were young, healthy, athletic adult males (average weight, 218 pounds) who underwent relatively minor, uncomplicated surgical procedures under general anesthesia. Five of these patients were collegiate and/or professional athletes and had meticulous medical records detailing their clinical course. Clinical laryngospasm was noted immediately following extubation and anesthesia by mask with subsequent pulmonary edema. The diagnoses were confirmed by clinical examination, arterial blood gas determinations or pulse oximetry, and chest roentgenogram. Four adults required reintubation. Six of the seven adults demonstrated very rapid resolution of the pulmonary edema with prompt diagnosis and institution of a therapeutic regimen including oxygen, diuretics, reintubation, and/or positive pressure ventilation. In one patient, the problem was not immediately recognized, and progressed to florid pulmonary edema requiring emergent intubation 14 hours later in the emergency room, and 3 days of mechanical ventilation. The etiology of pulmonary edema following upper airway obstruction represents an interplay between several factors: cardiogenic and neurogenic mechanisms, as well as hypoxia contribute. In this group, excessive negative intrathoracic pressure generated by forced inspiration against a closed glottis is the most likely, consistent, and logical explanation. This study suggests that young, healthy, athletic males may be at increased risk for this complication.(ABSTRACT TRUNCATED AT 250 WORDS)
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González de Dios J, Ramos Lizana J, López López C. [Laryngitis epidemic (893 cases of acute laryngotracheitis and spastic croup). II. Clinical, diagnostic and therapeutic aspects]. ANALES ESPANOLES DE PEDIATRIA 1990; 32:417-22. [PMID: 2205139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We retrospectively review 893 cases of children, occurred in epidemic bout in September-October 1987, in order to study the usual management of his pathology in our hospital. In most cases (82.3%) diagnose was laryngitis or acute laryngitis without specification acute laryngotracheitis or spasmodic group. Epiglottitis was no detected in any case. Complementary tests were performed only in 5% of the patients, but they were of little help for the diagnose. Treatment applied was ambiental hummidiffication (95.5%), followed by water and alcohol impregned neck collar (87.2%), rectal magnesium-sulfate + papaverine (67.5%), epinephrine nebulization (63%), antibiotics (44.3%), steroids (9%), bronchodilatadors (4.8%). This therapeutic approach is discussed.
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Abstract
A 50-year-old woman underwent laryngoscopy. Postoperatively she received naloxone and was extubated. She developed severe laryngospasm and one hour later pulmonary edema. Both naloxone administration and laryngospasm can provoke pulmonary edema; the pathophysiology is discussed. It is suggested that naloxone is administered with care to patients who in the preceding hours have had severe laryngospasm.
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61
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Aviv JE, Sanders I, Silva D, Kraus WM, Wu BL, Biller HF. Overcoming laryngospasm by electrical stimulation of the posterior cricoarytenoid muscle. Otolaryngol Head Neck Surg 1989; 100:110-8. [PMID: 2495506 DOI: 10.1177/019459988910000206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The intent of this study was to demonstrate that the technique of transmucosal electrical stimulation of laryngeal muscles may be of clinical use in airway management. Specifically, its ability to overcome laryngospasm was evaluated. Laryngospasm was induced in eight tracheotomized dogs by hyperventilating each dog, and then applying 0.1 M ammonia to the laryngeal mucosa while administering continuous positive airway pressure (CPAP). Laryngospasm was defined by steady apposition of the vocal cords, massive electromyographic activity in the laryngeal adductor muscles, absence of such activity in the posterior cricoarytenoid muscle (PCA), and intraglottic pressure greater than 80 mm Hg. Upon transmucosal application of 10 mAmp current to the PCA bilaterally, the vocal cords abducted for the duration of the stimulus. We theorize that overcoming laryngospasm by electrostimulation involves a reflexive inhibition of the laryngeal adductors. This study provides an objective model for laryngospasm, and demonstrates that electrical manipulation of the vocal cords may have clinical relevance.
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62
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Ferguson CC, Mann C. Laryngospasm-induced pulmonary edema. AANA JOURNAL 1989; 57:53-5. [PMID: 2929244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Laryngospasm is one of the more common forms of airway obstruction encountered by an anesthetist. Therapy usually is straightforward, with resolution of the obstruction normally occurring within minutes. In some cases, however, the patient's vigorous inspiratory efforts may lead to a rapidly deteriorating form of pulmonary edema. Two cases are presented that are quite typical of the development of this complication. The etiology, recognition and management of this form of non-cardiac pulmonary edema is discussed.
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63
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64
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Gacek RR. Botulinum toxin for relief of spasmodic dysphonia. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 1987; 113:1240. [PMID: 3663359 DOI: 10.1001/archotol.1987.01860110106025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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65
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Wiersbitzky S, Hein J. [Recommendations for the diagnosis and therapy of acute stenosing subglottic laryngitis (pseudocroup)]. KINDERARZTLICHE PRAXIS 1985; 53:301-4. [PMID: 4046334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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66
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McGonagle M, Kennedy TL. Laryngospasm induced pulmonary edema. Laryngoscope 1984; 94:1583-5. [PMID: 6503578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Two case reports of laryngospasm-induced pulmonary edema following general anesthesia are presented. Therapy consisted of immediate reintubation, application of positive pressure ventilation, and diuresis. This phenomenon should be recognized rapidly with appropriate therapy instituted immediately to avoid other complications. Preventive measures are discussed and a modified protocol of the management is outlined.
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67
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Pearce H. Laryngeal spasm. Anaesth Intensive Care 1983; 11:389-90. [PMID: 6650815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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68
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Fedorova EV, Blinovskaia OP. [Rendering emergency care to young infants]. FEL'DSHER I AKUSHERKA 1983; 48:32-7. [PMID: 6557923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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69
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70
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de Smet PA, Grote JJ, Jonkman JH. [The practical initial management of pseudocroup]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 1982; 126:63-5. [PMID: 7054732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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71
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Mostovoi IM. [Complications occurring during bronchological manipulations, their treatment and prevention]. PROBLEMY TUBERKULEZA 1982:42-5. [PMID: 7058190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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72
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Clinical Conferences at The Johns Hopkins Hospital. Upper airway obstruction in asthma. THE JOHNS HOPKINS MEDICAL JOURNAL 1980; 147:233-237. [PMID: 7453003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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73
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Komesaroff D. Resuscitation at the site of a road accident. AUSTRALIAN FAMILY PHYSICIAN 1978; 7:407-18. [PMID: 646743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Seven per cent of deaths resulting from motor car accidents are due to asphyxia without any other major injury. This highlights the importance of maintaining an unobstructed airway in patients following motor vehicle accidents. These cases of asphyxia are due to laryngeal spasm, aspirated foreign material, or pharyngeal obstruction by the tongue in a semi-conscious or unconscious patient. It is reasonable to assume that many of these lives could be saved by simple techniques, such as removing foreign material from the pharynx, pulling the chin and head back firmly, and turning the patient into the lateral position.
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74
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Abstract
This article reviews some of the problems involved in direct laryngoscopy. It suggests adequate preparation and evaluation of the patient to avoid complications. An evaluation of laryngospasm is given. Solutions of the problems are suggested using gear power assistance and adequate drugs for relaxation. The importance of correct positioning of the patient is emphasized and illustrated. This summarizes clinical judgment and successful evaluation of the difficult mechanical problems in the exposure of the vocal cords.
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75
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Ambrosio A. The types of croup and how to treat them. NURSING CARE 1974; 7:18-24. [PMID: 4492671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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