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The Efficacy of Ultrasound-Guided Superior Laryngeal Nerve Block as an Adjuvant to General Anesthesia during Suspension Laryngoscopy Vocal Cord Polypectomy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1594829. [PMID: 35800013 PMCID: PMC9256407 DOI: 10.1155/2022/1594829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
Abstract
Background In the current study, we assessed the effect of the ultrasound-guided internal branch of the upper laryngeal nerve (USG-guided iSLN) block combined with general anesthesia on perioperative sore throat (POST), cough, hoarseness of voice, intraoperative hemodynamic changes, and the quality of early recovery for the patients undergoing suspension laryngoscopy vocal cord polypectomy (SLVCP). Methods This was a randomized controlled trail. Eighty patients, aged from 18 to 70 years old, ASA I ∼ II, scheduled for polypectomy of the vocal cord by using a laryngoscope, were randomized into 2 groups (n = 40 each) using a random number table. Patients in group C received general anesthesia (GA), whereas those in group S received USG-guided iSLN block bilaterally (37.5 mg of 0.375% ropivacaine, 5 ml each side) combined with GA. The primary outcome was the quality of patients' recovery using the Quality of Recovery Questionnaire (QoR-9). The secondary outcomes were postoperative cough, sore throat, hoarseness of voice, and hemodynamic changes in both groups at corresponding time points. The adverse reactions such as postoperative chocking, or aspiration, and dyspnea was recorded as well. Results The QoR-9 scores of patients in group C were lower than those of group S at time points of D1∼D2 (P < 0.05). Patients in group S had a significantly lower incidence of perioperative cough than those in group C in the early postoperative period (1 hour after extubation) (P < 0.05), the scores of sore throat were lower in group S than those in group C (P < 0.05), the incidence of postoperative hoarseness was increased in group S than that in group C at the time points of 30 min, 2 h, and 4 h after extubation (P < 0.05); however, the incidence of postoperative hoarseness was decreased in group S than that in group C at the time point of 24 h after extubation (P < 0.05). MAP and HR of group S was lower than those of group C at time points of T1∼T4 (P < 0.05). No serious adverse events were observed in both groups. Conclusion The study found that the application of ultrasound guided superior laryngeal nerve block combined with general anesthesia for the patients undergoing SLVCP could effectively promote the quality of early recovery. Clinical trial registration: This trial is registered with NCT05309174. The date of registration: March 12th 2021.Trial registry name: The Study of Bilateral Upper Laryngeal Nerve Block for Supporting the Removal of Vocal Cord Polyps Under Laryngoscopy.
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Kostyk P, Francois K, Salik I. Airway Anesthesia for Awake Tracheal Intubation: A Review of the Literature. Cureus 2021; 13:e16315. [PMID: 34405073 PMCID: PMC8354742 DOI: 10.7759/cureus.16315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2021] [Indexed: 12/22/2022] Open
Abstract
Airway topicalization is frequently utilized by anesthesiologists to facilitate open airway procedures, aid intubation for a difficult airway, and prevent adverse respiratory events. This review article summarizes the techniques available for airway topicalization for a patient who is deemed to be difficult to intubate. We focus on the indications for use, local anesthetic maximum dosages and safety profiles, sedation techniques, and trials and pitfalls during airway topicalization for difficult intubation.
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Affiliation(s)
- Piotr Kostyk
- Anesthesiology, Westchester Medical Center, Valhalla, USA
| | - Karen Francois
- Anesthesiology, Westchester Medical Center, Valhalla, USA
| | - Irim Salik
- Anesthesiology, Westchester Medical Center, Valhalla, USA
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Kojima Y, Sugimura M. Superior Laryngeal Nerve Block for Intubation in Patients With COVID-19. Anesth Prog 2021; 68:50-51. [PMID: 33827124 DOI: 10.2344/anpr-68-01-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/20/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Yuki Kojima
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Mitsutaka Sugimura
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Liao YC, Wu WC, Hsieh MH, Chang CC, Tsai HC. Ultrasound-guided superior laryngeal nerve block assists in anesthesia for bronchoscopic surgical procedure: A case report of anesthesia for rigid bronchoscopy. Medicine (Baltimore) 2020; 99:e20916. [PMID: 32629688 PMCID: PMC7337557 DOI: 10.1097/md.0000000000020916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Evolving techniques in the field of therapeutic bronchoscopy have led to the return of rigid bronchoscopy in the treatment of complex central airway disease. Rigid bronchoscopy is typically performed under general anesthesia because of the strong stimulation caused by metal instruments. Anesthesia for rigid bronchoscopy is challenging to administer because anesthesiologists and interventionists share the same working channel: the airway. Previously reviewed anesthetic methods are used primarily for short procedures. Balanced anesthesia with ultrasound-guided superior laryngeal nerve (SLN) block and total intravenous anesthesia might provide anesthesia for a prolonged procedure and facilitate patient recovery. PATIENT CONCERNS A patient with obstructed endobronchial stent was referred for therapeutic rigid bronchoscopy, which requires deeper anesthesia than flexible bronchoscopy. There were concerns of the stronger stimulation of the rigid bronchoscopy, lengthy duration of the procedure, higher risk of hypoxemia, and the difficulty of mechanical ventilation weaning after anesthesia due to the patients co-morbidities. DIAGNOSIS A 66-year-old female patient presented with a history of breast cancer with lung metastases. Right main bronchus obstruction due to external compression of lung metastases was relieved through insertion of an endobronchial stent, but obstructive granulation developed after 4 months. Presence of the malfunctioning stent caused severe cough and discomfort. Removal of the stent by using a flexible bronchoscope was attempted twice but failed. INTERVENTIONS Regional anesthesia of the upper airway through ultrasound-guided SLN block combined with intratracheal 2% lidocaine spray was performed to assist in total intravenous anesthesia (TIVA) during rigid bronchoscopy. OUTCOMES The patient maintained steady spontaneous breathing throughout the procedure without laryngospasm, bucking, or desaturation. Emergence from anesthesia was smooth and rapid after propofol infusion was discontinued. The surgery lasted 2.5 hours without discontinuity, and no perioperative pulmonary or cardiovascular complications were noted. CONCLUSION Ultrasound-guided SLN block is a simple technique with a high success rate and low complication rate. Application of SLN block to assist TIVA provides sufficient anesthesia for lengthened therapeutic rigid bronchoscopy without interruption and facilitates patient recovery.
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Affiliation(s)
| | - Wei-Ciao Wu
- Division of Thoracic Surgery, Department of Surgery, Taipei Medical University Hospital
| | | | - Chuen-Chau Chang
- Department of Anesthesiology
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
| | - Hsiao-Chien Tsai
- Department of Anesthesiology
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Guri M, Dhawan S, Bhati K, Aeron N. Comparison of airway blocks versus general anaesthesia for diagnostic direct laryngoscopy: A randomised comparative trial. Indian J Anaesth 2020; 64:1054-1058. [PMID: 33542569 PMCID: PMC7852433 DOI: 10.4103/ija.ija_680_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/25/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Objective: Direct rigid laryngoscopy and general anaesthesia (GA) are associated with many problems. Regional anaesthesia/airway blocks can be considered as safer and easier alternative techniques especially among old and comorbid patients and conditions with difficult airways as well. The present study was conducted to compare efficacy of regional anaesthesia/airway blocks versus general anaesthesia for diagnostic direct (rigid) laryngoscopy. Methods: A randomised comparative trial was conducted among patients undergoing diagnostic direct laryngoscopy (DLS) for perilaryngeal lesions. Eighty patients of either sex aged between 20and 80 years and categorised as American Society of Anesthesiologists(ASA) grade I, II, III or IV were divided under two groups of 40 patients each. Group-A underwent DLS with airway blocks and group-B underwent DLS under GA. Haemodynamic parameters and analgesia were interpreted statistically. Results: Difference in haemodynamic stability and quality of post- operative analgesia were primary outcomes. Patients in group-A were observed to be haemodynamically more stable as compared to group-B patients with statistically significant P value (0.003 and 0.016 for pulse rate at 6 min and mean arterial pressure at 4 min, respectively). In postoperative period, group-A patients were found to be more comfortable (lower VAS scores) than group-B patients with P value (0.040, 0.043, 0.044 at 0, 5, 15 min, respectively). Conclusion: Regional airway blocks provide better haemodynamic stability and postoperative analgesia than general anaesthesia.
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Superior laryngeal nerve block as an adjuvant to General Anesthesia during endoscopic laryngeal surgeries. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kumar P, Kaur T, Atwal GK, Bhupal JS, Basra AK. Comparison of Intubating Conditions using Fentanyl plus Propofol Versus Fentanyl plus Midazolam during Fiberoptic Laryngoscopy. J Clin Diagn Res 2017; 11:UC21-UC24. [PMID: 28893016 PMCID: PMC5583785 DOI: 10.7860/jcdr/2017/26479.10220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Awake nasal or oral flexible fiberoptic intubation is the airway management technique of choice in known or anticipated difficult airway, unstable cervical fracture, limited mouth opening (as in temporomandibular joint disease), mandibular-maxillary fixation and severe facial burns. Both optimal intubating condition and patient comfort are important for fiberoptic intubation. Optimal intubating conditions provided by an ideal sedation regimen would ensure haemodynamic stability, patient comfort, attenuation of airway reflexes and amnesia. AIM To compare the intubating conditions using fentanyl plus propofol versus fentanyl plus midazolam during fiberoptic laryngoscopy. MATERIALS AND METHODS A prospective, comparative and randomized study was conducted on 60 patients of either gender aged between 18 and 60 years belonging to the American Society of Anaesthesiologists (ASA) grade-I or II scheduled for elective surgery. Patients were randomly allocated into two groups of 30 each. In group I, patients received i.v. fentanyl 1 μg/kg+ propofol 1 mg/kg to achieve an adequate level of sedation that is Ramsay Sedation Scale (RSS) score of 3. In group II, patients received i.v. fentanyl 1 μg/kg + midazolam 0.03 mg/kg to achieve RSS= score of 3. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure, mean arterial pressure), SpO2, EtCO2, total comfort scale values and patient's tolerance were assessed during preoxygenation, fiberscope insertion and endotracheal intubation. RESULTS Fentanyl plus midazolam group showed better patient comfort and maintenance of oxygen saturation than fentanyl plus propofol group during fiberoptic intubation. CONCLUSION Both fentanyl plus midazolam and fentanyl plus propofol regimes are suitable for fiberoptic intubation. Fentanyl plus midazolam appeared to offer better tolerance, preservation of an airway and spontaneous ventilation, while maintaining haemodynamic stability.
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Affiliation(s)
- Parmod Kumar
- Professor and Head, Department of Anaesthesiology and Intensive Care, GMC and RH, Patiala, Punjab, India
| | - Tripat Kaur
- Associate Professor, Department of Anaesthesiology and Intensive Care, GMC and RH, Patiala, Punjab, India
| | - Gurpreet Kaur Atwal
- Junior Resident, Department of Anaesthesiology and Intensive Care, GMC and RH, Patiala, Punjab, India
| | - Jatinderpaul Singh Bhupal
- Retired Professor and Head, Department of Anaesthesiology and Intensive Care, GMC and RH, Patiala, Punjab, India
| | - Ajay Kumar Basra
- Junior Resident, Department of Anaesthesiology and Intensive Care, GMC and RH, Patiala, Punjab, India
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Wu JP, Liu H, An JX, Cope DK, Williams JP. Three Cases of Idiopathic Superior Laryngeal Neuralgia Treated by Superior Laryngeal Nerve Block under Ultrasound Guidance. Chin Med J (Engl) 2017; 129:2007-8. [PMID: 27503030 PMCID: PMC4989436 DOI: 10.4103/0366-6999.187859] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jian-Ping Wu
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China
| | - Hui Liu
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China
| | - Jian-Xiong An
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China
| | - Doris K Cope
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh 15213, USA
| | - John P Williams
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh 15213, USA
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Ambi US, Arjun BK, Masur S, Endigeri A, Hosalli V, Hulakund SY. Comparison of ultrasound and anatomical landmark-guided technique for superior laryngeal nerve block to aid awake fibre-optic intubation: A prospective randomised clinical study. Indian J Anaesth 2017; 61:463-468. [PMID: 28655950 PMCID: PMC5474913 DOI: 10.4103/ija.ija_74_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background and Aims: Ultrasonography has emerged as a novel, portable, non-invasive tool encouraging airway assessment and procedural interventions. This study assesses the feasibility of ultrasound for block of internal branch of superior laryngeal nerve (ibSLN) block during upper airway anaesthesia to aid awake fibre-optic intubation. Methods: Forty American Society of Anesthesiologists’ physical status I–II patients, aged 18–60 years, deemed to have a difficult airway (modified Mallampati class III–IV or inter-incisor distance <2.5 cm) and planned for awake fibre-optic intubation were randomised to either landmark group (L, n = 20) or ultrasound group (U, n = 20). All patients received nebulised 4% lignocaine (3 mL) and transtracheal injection 3 mL 2% lignocaine. Group L received landmark-guided bilateral ibSLN block with 1 mL 2% lignocaine. Group U received bilateral ibSLN block with 1 mL 2% lignocaine using a high-frequency ultrasound transducer to define the SLN space. The primary objective was assessment of quality of airway anaesthesia. Secondary objectives were time for intubation, haemodynamic parameters and patient perception of discomfort during procedure. Results: The quality of anaesthesia was significantly better in Group U than in Group L (P < 0.001). The mean time for intubation was shorter in Group U (71.05 ± 9.57 s) compared to Group L (109.05 ± 30.09 s, P < 0.001). Heart rate, mean arterial pressure and patient perception of discomfort were significantly increased in Group L. Conclusion: Ultrasound for ibSLN block as a part of preparation for awake fibre-optic intubation improves quality of airway anaesthesia and patient tolerance.
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Affiliation(s)
- Uday S Ambi
- Department of Anaesthesiology, SN Medical College, Bagalkot, Karnataka, India
| | - B K Arjun
- Deparment of Anaesthesiology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Shilpa Masur
- Department of Anaesthesiology, SN Medical College, Bagalkot, Karnataka, India
| | - Archana Endigeri
- Department of Anaesthesiology, SN Medical College, Bagalkot, Karnataka, India
| | - Vinod Hosalli
- Department of Anaesthesiology, SN Medical College, Bagalkot, Karnataka, India
| | - S Y Hulakund
- Department of Anaesthesiology, SN Medical College, Bagalkot, Karnataka, India
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Sawka A, Tang R, Vaghadia H. Sonographically guided superior laryngeal nerve block during awake fiberoptic intubation. ACTA ACUST UNITED AC 2015; 4:107-10. [PMID: 25867195 DOI: 10.1213/xaa.0000000000000136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report 5 patients who underwent ultrasound-guided superior laryngeal nerve block before awake intubation and general anesthesia. We used a 8- to 15-MHz hockey stick-shaped ultrasound transducer (HST15-8/20 linear probe, Ultrasonix) to visualize the superior laryngeal nerve. A 3.8-cm 25-G needle was inserted in real time and directed toward the superior laryngeal nerve followed by circumferential placement of local anesthetic. All 5 patients tolerated subsequent awake fiberoptic intubation with either minimal or no sedation. Sonographically guided superior laryngeal nerve block may be useful in patients where identification of landmarks in the neck is difficult as a result of patient anatomy.
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Affiliation(s)
- Andrew Sawka
- From the Department of Anesthesiology, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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11
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Lan CH, Cheng WC, Yang YL. A new method for ultrasound-guided superior laryngeal nerve block. Tzu Chi Med J 2013. [DOI: 10.1016/j.tcmj.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kaur B, Tang R, Sawka A, Krebs C, Vaghadia H. A method for ultrasonographic visualization and injection of the superior laryngeal nerve: volunteer study and cadaver simulation. Anesth Analg 2012; 115:1242-5. [PMID: 22822197 DOI: 10.1213/ane.0b013e318265f75d] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Superior laryngeal nerve block is a valuable technique for provision of upper airway anesthesia. In bilateral scans of 20 volunteers, we developed a technique for ultrasonographic visualization of the superior laryngeal nerve and key anatomical structures using a hockey stick-shaped 8 to 15 MHz transducer (HST15 to 8/20 linear probe, Ultrasonix, Richmond, BC, Canada). Subsequently, we simulated superior laryngeal nerve scanning and injection in bilateral injections in 2 cadavers. Ultrasound-guided in-plane advancement of a needle toward the superior laryngeal nerve and injection of 1 mL of green dye was achieved in all 4 attempts and confirmed by a postprocedural dissection performed by an anatomist. We conclude that ultrasound-guided superior laryngeal nerve block in humans may be feasible.
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Affiliation(s)
- Balvindar Kaur
- Department of Anesthesia, Vancouver Coastal Health, Vancouver, BC V5Z 1M9, Canada.
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Barberet G, Henry Y, Tatu L, Berthier F, Besch G, Pili-Floury S, Samain E. Ultrasound description of a superior laryngeal nerve space as an anatomical basis for echoguided regional anaesthesia. Br J Anaesth 2012; 109:126-8. [DOI: 10.1093/bja/aes203] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Green JS, Tsui BC. Head and Neck Ultrasound: Applications Relevant to Anesthesia and Intensive Care Medicine. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.cult.2011.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Manikandan S, Neema PK, Rathod RC. Ultrasound-Guided Bilateral Superior Laryngeal Nerve Block to Aid Awake Endotracheal Intubation in a Patient with Cervical Spine Disease for Emergency Surgery. Anaesth Intensive Care 2010; 38:946-8. [DOI: 10.1177/0310057x1003800523] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultrasound has been widely used to locate nerves for various nerve blocks. The potential advantages of using ultrasound imaging for nerve blocks include reduction in the amount of local anaesthetic required, improved success rate, reduced time to perform the block and reduced complication rate. We describe the successful performance of ultrasound-guided bilateral superior laryngeal nerve block to facilitate awake fibreoptic intubation in a patient presenting for emergency surgery on the cervical spine.
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Affiliation(s)
- S. Manikandan
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. K. Neema
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - R. C. Rathod
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Green JS, Tsui BCH. Applications of ultrasonography in ENT: airway assessment and nerve blockade. Anesthesiol Clin 2010; 28:541-553. [PMID: 20850084 DOI: 10.1016/j.anclin.2010.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article presents a comprehensive narrative review of the published literature relating to ultrasound imaging relevant to anesthesia for ear, nose, and throat (ENT) surgery. The review comprises 2 main subject areas: the use of ultrasonography related to assessment and management of the airway, and the use of ultrasonography related to nerve blockade for ENT surgery. The relevant sonoanatomy and suitable probe placement are illustrated in relation to applicable regional anatomy (they are not discussed). The possible value of the use of ultrasonography to improve existing clinical practice in these areas is explored.
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Affiliation(s)
- James S Green
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
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Kochilas X, Bibas A, Xenellis J, Anagnostopoulou S. Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery. Clin Anat 2008; 21:99-105. [PMID: 18288760 DOI: 10.1002/ca.20604] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Injury of the external branch of the superior laryngeal nerve (EBSLN) increases the morbidity following a variety of neck procedures and can have catastrophic consequences in people who use their voice professionally. Identification and preservation of the EBSLN are thus important in thyroidectomy, parathyroidectomy, carotid endarterectomy, and anterior cervical spine procedures, where the nerve is at risk. There are large variations in the anatomical course of the EBSLN, which makes the intraoperative identification of the nerve challenging. The topographic relationship of the EBSLN to the superior thyroid artery and the upper pole of the thyroid gland are considered by many authors to be the key point for identifying the nerve during surgery of the neck. The classifications by Cernea et al. ([1992a] Head Neck 14:380-383; [1992b] Am. J. Surg. 164:634-639) and by Kierner et al. ([1998] Arch. Otolaryngol. Head Neck Surg. 124:301-303), as well as clinically important connections are discussed in detail. Along with sound anatomical knowledge, neuromonitoring is helpful in identifying the EBSLN during neck procedures. The clinical signs of EBSLN injury include hoarseness, decreased voice projection, decreased pitch range, and fatigue after extensive voice use. Videostroboscopy, electromyography, voice analysis, and electroglottography can provide crucial information on the function of the EBSLN following neck surgery.
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Affiliation(s)
- Xenophon Kochilas
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Greece
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Abrão J, Khabbaz KM, Abrão JM, Coutinho DJ, Juliano EAC. Unusual foreign body in the esophagus: a challenge for the anesthesiologist. Acta Anaesthesiol Scand 2003; 47:1176-7. [PMID: 12969116 DOI: 10.1034/j.1399-6576.2003.00217.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A foreign body in the esophagus is usually removed by endoscopy. An elder man entered the emergency room dyspneic and dysphagic. A chest X-ray showed that he had a table fork stuck in the upper esophagus. An endoscopist tried to remove it without success. After bilateral block of the superior laryngeal nerve, transtracheal injection, topical anesthesia of the mouth, and sedation, an awake laryngoscopy was carried out. Pushing the laryngoscope into the opening of the esophagus the fork was seen and extracted by the anesthesiologist. This case focuses on the role of the anesthesiologist in the removal of esophageal foreign bodies.
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Affiliation(s)
- J Abrão
- Department of Anesthesiology of the Faculty of Medicine of Triângulo Mineiro, Uberaba-MG, Brazil.
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Bibliography Current World Literature. Curr Opin Anaesthesiol 2003. [DOI: 10.1097/01.aco.0000084472.59960.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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