Asystole following Reintubation during Suspension Laryngoscopy

Asystole during Suspension Laryngoscopy: Case Report, Literature Review, and Prophylactic Strategies

Transoral laryngeal procedures are considered minimally invasive but may trigger important complications such as severe bradycardia and even asystole mediated by vagal reflex. The literature on this subject is rare. This article aims to review the literature, explain associated mechanisms, establish prophylactic strategies, and highlight the importance of intraoperative safety protocols.

Development and Validation of a Low-Cost and Simple Simulator for Microlaryngeal Surgery

Objectives.

The simulation of microlaryngeal skills is rarely seen in surgical training, but it is particularly important in phonomicrosurgery. This study described and validated the laryngeal surgical simulator through surgical training.

Methods.

A simple and low-cost simulator was developed for the fixation of the suspension laryngoscope and porcine larynges. Twenty participants with work skills and experience did preparation before training, and performed suture and carbon dioxide (CO₂) laser cordectomy for simulator evaluation. The results were proposed by the aspects of time taken for each procedure, the global rating scale, a procedure-specific assessment, and a post-simulation questionnaire.

Results.

All participants completed the preparation within 9 minutes and reached the conclusion that the microlaryngeal surgical simulator was helpful in improving their surgical skills. The performance of experts was superior to that of novices in both suture and CO₂ laser cordectomy.

Conclusion.

This simulator could be easily assembled and was successfully validated by microlaryngeal surgical training both subjectively and objectively. It may be helpful to clinicians in microlaryngeal skills.

Asystole From Direct Laryngoscopy: A Case Report and Literature Review

The rare and potentially fatal complication of asystole during direct laryngoscopy is linked to direct vagal stimulation. This case describes asystole in an 85-year-old female who underwent suspension microlaryngoscopy with tracheal dilation for subglottic stenosis. Quick recognition of this rare event with immediate cessation of laryngoscopy resulted in the return of normal sinus rhythm. This incident emphasizes the implications of continued vigilance during laryngoscopy and the importance of communication between the anesthesia and surgical staff to identify and treat this rare complication. The case was successfully concluded by premedication with an anticholinergic and by increasing the depth of anesthesia.