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Wang L, Peng WP, Yan CL, Zuo MZ. Arytenoid dislocation after i-gel laryngeal mask insertion was resolved by closed reduction. J Clin Anesth 2020; 66:109915. [PMID: 32563072 DOI: 10.1016/j.jclinane.2020.109915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/07/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Lin Wang
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China
| | - Wen-Ping Peng
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China
| | - Chun-Ling Yan
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China.
| | - Ming-Zhang Zuo
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China.
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Ruananukun N, Watcharotayangul J, Jeeranukosol S, Komonhirun R. Correlation and variation of cuff inflating volumes and pressures in different adult models of laryngeal mask: a prospective randomized trial. BMC Anesthesiol 2020; 20:108. [PMID: 32380954 PMCID: PMC7206679 DOI: 10.1186/s12871-020-01028-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperinflation of laryngeal mask cuffs may carry the risk of airway complications. The manufacturer recommends inflating cuff until the intracuff pressure reaches 60 cmH2O, or inflate with the volume of air to not exceed the maximum recommended volume. We prospectively assessed the correlation of cuff inflating volumes and pressures, and the appropriated the cuff inflating volumes to generate an intracuff pressure of 60 cmH2O in the adult laryngeal masks from different manufacturers. METHODS Two groups of 80 patients requiring laryngeal mask size 3 and 4 during general anesthesia were randomized into 4 subgroups for each size of the laryngeal mask: Soft Seal® (Portex®), AuraOnce™ (Ambu®), LMA-Classic™ (Teleflex®) and LMA-ProSeal™ (Teleflex®). After insertion, the cuff was inflated with 5-ml increments of air up to the maximum recommended volume. After each 5-ml intracuff pressure was measured, the volume of air that generated the intracuff pressure of 60 cmH2O was recorded. RESULTS Mean (SD) volume of air required to achieve the intracuff pressure of 60 cmH2O in Soft Seal®, AuraOnce™, LMA-Classic™, LMA-ProSeal™ laryngeal mask size 3 were 11.80(1.88), 9.20(1.88), 8.95(1.50) and 13.50(2.48) ml, respectively, and these volumes in laryngeal mask size 4 were 14.45(4.12), 12.55(1.85), 11.30(1.95) and 18.20(3.47) ml, respectively. The maximum recommended volume resulted in high intracuff pressures (> 60 cmH2O) in all laryngeal mask types and sizes studied. CONCLUSION Pressure-volume curves of adult laryngeal masks are all in sigmoidal shape. Cuff designs and materials can effect pressure and volume correlation. Approximately half of the maximum recommended volume is required to achieve the intracuff pressure of 60 cmH2O except LMA-ProSeal™ which required two-thirds of the maximum recommended volume. TRIAL REGISTRATION Thai Clinical Trials Registry, TCTR20150602001, May 28, 2015.
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Affiliation(s)
- Narut Ruananukun
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
| | - Jittiya Watcharotayangul
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
| | - Suchaya Jeeranukosol
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
| | - Rojnarin Komonhirun
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rajchathewi, Bangkok, 10400 Thailand
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Gorbea E, Mori M. Two Cases of Bilateral Vocal Fold Mobility Impairment After LMA Use In 7 Months. Ann Otol Rhinol Laryngol 2018; 127:653-656. [PMID: 30047792 DOI: 10.1177/0003489418784061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To increase awareness of vocal fold mobility impairment secondary to laryngeal mask airway (LMA) use in the operating room. METHODS We report 2 cases of bilateral vocal fold mobility impairment after LMA use within 7 months of each other. One patient is a 52-year-old female who developed this complication after orthopedic elbow surgery. The second case is a 75-year-old male who presented after undergoing inguinal hernia repair. RESULTS The patient from the first case required a 7-day hospital stay in the SICU due to airway compromise with spontaneous resolution of right-sided vocal fold immobility and improvement of symptoms. The 75-year-old male required direct laryngoscopy and bilateral true vocal fold injection medialization to correct his bilateral vocal fold paresis causing dysphonia and aspiration of liquids. CONCLUSIONS Bilateral vocal fold immobility secondary to LMA use is likely an underreported phenomenon of which otolaryngologists and anesthesiologists should be aware. Presentation may be severe, requiring hospitalization or operative intervention.
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Affiliation(s)
- Enrique Gorbea
- 1 Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Matthew Mori
- 1 Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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Chun EH, Baik HJ, Chung RK, Lee HJ, Shin K, Woo JH. Arytenoid cartilage dislocation mimicking bilateral vocal cord paralysis: A case report. Medicine (Baltimore) 2017; 96:e8514. [PMID: 29137052 PMCID: PMC5690745 DOI: 10.1097/md.0000000000008514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Arytenoid dislocation is very rare and may be misdiagnosed as vocal cord paralysis or a self-limiting sore throat. PATIENT CONCERNS A 70-year-old male (70 kg, 156 cm) was scheduled for transurethral resection of bladder tumors. A McGrath videolaryngoscope, with a basic cuffed Mallinckrodt oral tracheal tube of 7.5 mm internal diameter, was used to successfully intubate his trachea. The duration of surgery was 25 minutes. In the recovery room, he complained of sore throat and dyspnea with inspiratory stridor, which were not resolved after intravenous injection of 10 mg of dexamethasone. DIAGNOSES The otolaryngological examination revealed midline fixation of the bilateral vocal folds, suggestive of bilateral arytenoid dislocation or bilateral vocal cord palsy. The latter was ruled out because there was no evidence of recurrent laryngeal nerve injury. INTERVENTIONS Under general anesthesia, a closed reduction was performed using laryngoscopic forceps to apply posterolateral pressure on the arytenoid joints on both sides. Only the dislocation of the left cricoarytenoid joint could be easily reduced, whereas reduction of the right joint was not possible. OUTCOMES On postoperative day 7, examination with a rigid laryngoscope showed a medially fixed right vocal fold, with full compensation by the left vocal fold. Computed tomography of the neck showed no pathologic findings. Six weeks after surgery, the patient had regained his normal voice with no complications. LESSONS Although arytenoid dislocation is a rare complication, it should be considered even in patients with uncomplicated tracheal intubation. Early diagnosis and the optimal therapeutic approach are critical for restoration of the patient's original vocal cord function.
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Affiliation(s)
- Eun H. Chun
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University
| | - Hee J. Baik
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University
| | - Rack K. Chung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University
| | - Hun J. Lee
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Kwangseob Shin
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Jae H. Woo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University
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Takeshita J, Nishiyama K, Fujii M, Tanaka H, Beppu S, Sasahashi N, Shime N. Repetitive postoperative extubation failure and cardiac arrest due to laryngomalacia after general anesthesia in an elderly patient: a case report. J Anesth 2017; 31:779-781. [PMID: 28508288 DOI: 10.1007/s00540-017-2373-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
The authors report a case involving an elderly patient who experienced repetitive perioperative cardiac arrest caused by laryngomalacia. The patient underwent surgery under general anesthesia; however, 2 h after initial extubation, he experienced cardiopulmonary arrest. Return of spontaneous circulation was achieved by immediate resuscitation. Four hours later, a second extubation was performed without any neurological complications. However, 2 h later, he experienced cardiopulmonary arrest again. Immediately after the third extubation, 12 h after the second cardiopulmonary arrest, fiberoptic laryngoscopy revealed laryngomalacia. His respiratory condition stabilized after emergent tracheostomy. Laryngomalacia should be considered even in adult cases when signs of upper airway obstruction manifest after extubation.
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Affiliation(s)
- Jun Takeshita
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Masashi Fujii
- Department of Anesthesiology, Nagahama Red Cross Hospital, Shiga, Japan
| | - Hiroyuki Tanaka
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Satoru Beppu
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Sim YH, Choi JH, Kim MK. Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report. Korean J Anesthesiol 2016; 69:382-5. [PMID: 27482316 PMCID: PMC4967634 DOI: 10.4097/kjae.2016.69.4.382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/11/2015] [Accepted: 09/14/2015] [Indexed: 11/10/2022] Open
Abstract
Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position.
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Affiliation(s)
- Yeo Hae Sim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jeong-Hyun Choi
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Mi Kyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Medical Center, Seoul, Korea
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Van Zundert TC, Hendrickx JF, De Witte JL, Wong DT, Cattano D, Brimacombe JR. Do mask aperture bars of extraglottic airway devices prevent prolapse of epiglottis causing airway obstruction? A randomized crossover trial in anesthetized adult patients. J Clin Anesth 2016; 31:231-7. [DOI: 10.1016/j.jclinane.2015.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/28/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
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Michalek P, Donaldson W, Vobrubova E, Hakl M. Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine. BIOMED RESEARCH INTERNATIONAL 2015; 2015:746560. [PMID: 26783527 PMCID: PMC4691459 DOI: 10.1155/2015/746560] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Some devices now have features mitigating risk of aspiration, such as drain tubes or compartments to manage regurgitated content. Despite this, the use of these device may be associated with various complications including aspiration. This review highlights the types and incidence of these complications. They include regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury. The incidence of such complications is quite low, but as some carry with them a significant degree of morbidity the need to follow manufacturers' advice is underlined. The incidence of gastric content aspiration associated with the devices is estimated to be as low as 0.02% with perioperative regurgitation being significantly higher but underreported. Other serious, but extremely rare, complications include pharyngeal rupture, pneumomediastinum, mediastinitis, or arytenoid dislocation. Mild short-lasting adverse effects of the devices have significantly higher incidence than serious complications and involve postoperative sore throat, dysphagia, pain on swallowing, or hoarseness. Devices may have deleterious effect on cervical mucosa or vasculature depending on their cuff volume and pressure.
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Affiliation(s)
- Pavel Michalek
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
- University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK
| | - William Donaldson
- Department of Anaesthetics, Antrim Area Hospital, Bush Road, Antrim BT41 4RD, UK
| | - Eliska Vobrubova
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty, Charles University in Prague and General University Hospital, U Nemocnice 2, 120 21 Prague, Czech Republic
| | - Marek Hakl
- Department of Anaesthesia and Intensive Medicine, St. Anne University Hospital, Pekarska 53, 656 91 Brno, Czech Republic
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Rosen CA, Mau T, Remacle M, Hess M, Eckel HE, Young VN, Hantzakos A, Yung KC, Dikkers FG. Nomenclature proposal to describe vocal fold motion impairment. Eur Arch Otorhinolaryngol 2015; 273:1995-9. [PMID: 26036851 PMCID: PMC4930794 DOI: 10.1007/s00405-015-3663-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/12/2015] [Indexed: 11/27/2022]
Abstract
The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis.
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Affiliation(s)
- Clark A Rosen
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marc Remacle
- Department of ORL-Head and Neck Surgery, Louvain University Hospital of Mont-Godinne, Yvoir, Belgium
| | - Markus Hess
- Department of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans E Eckel
- Abteilung Hals-, Nasen- u Ohrenkrankheiten, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - VyVy N Young
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anastasios Hantzakos
- First Department of ORL-HNS of University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Katherine C Yung
- Department of Otolaryngology, University of California at San Francisco, San Francisco, CA, USA
| | - Frederik G Dikkers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Shen L, Wang WT, Yu XR, Zhang XH, Huang YG. Evaluation of Risk Factors for Arytenoid Dislocation after Endotracheal Intubation: a Retrospective Case-control Study. ACTA ACUST UNITED AC 2014; 29:221-4. [DOI: 10.1016/s1001-9294(14)60074-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Thiruvenkatarajan V, Van Wijk RM, Rajbhoj A. Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series. Anaesthesia 2014; 70:344-59. [DOI: 10.1111/anae.12917] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
Affiliation(s)
- V. Thiruvenkatarajan
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - R. M. Van Wijk
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - A. Rajbhoj
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
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12
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Pediatric Arytenoid Dislocation: Diagnosis and Treatment. J Voice 2014; 28:115-22. [DOI: 10.1016/j.jvoice.2013.08.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/27/2013] [Indexed: 12/18/2022]
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Arytenoid Cartilage Dislocation After Laparoscopic Surgery for Treatment of Diabetes. ACTA ACUST UNITED AC 2013; 1:34-6. [DOI: 10.1097/acc.0b013e3182944da3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Goz V, Qureshi S, Hecht AC. Arytenoid dislocation as a cause of prolonged hoarseness after cervical discectomy and fusion. Global Spine J 2013; 3:47-50. [PMID: 24436851 PMCID: PMC3854589 DOI: 10.1055/s-0032-1329890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/08/2012] [Indexed: 11/06/2022] Open
Abstract
Study Design Case series of two arytenoid dislocations after anterior cervical discectomy. Objective To recognize arytenoid dislocation as a possible cause of prolonged hoarseness in patients after anterior cervical discectomies. Summary of Background Data Prolonged hoarseness is a common postoperative complication after anterior cervical spine surgery. The etiology of prolonged postoperative hoarseness is usually related to a paresis of the recurrent laryngeal nerve. However, other causes of postoperative hoarseness may be overlooked in this clinical scenario. Other possible etiologies include pharyngeal and laryngeal trauma, hematoma and edema, injury of the superior laryngeal nerve, as well as arytenoid cartilage dislocation. Arytenoid dislocation is often misdiagnosed as vocal fold paresis due to recurrent or laryngeal nerve injury. Methods We report two cases of arytenoid dislocation and review the literature on this pathology. Results Two patients treated with anterior cervical discectomy and fusion experienced prolonged postoperative hoarseness. Arytenoid dislocation was confirmed by flexible fiber-optic laryngoscopy in both cases. The dislocations experienced spontaneous reduction at 6 weeks and 3 months postsurgery. Conclusions Arytenoid dislocation must be considered in the differential diagnosis of prolonged postoperative hoarseness and evaluated for using direct laryngoscopy, computed tomography, or a laryngeal electromyography. Upon diagnosis, treatment must be considered immediately. Slight dislocations can reduce spontaneously without surgical intervention; however, operative intervention may be required at times.
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Affiliation(s)
- Vadim Goz
- Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, New York
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, New York
| | - Andrew C. Hecht
- Department of Orthopaedic Surgery, The Mount Sinai Medical Center, New York, New York,Address for correspondence Andrew C. Hecht, M.D. Leni and Peter W. May Department of Orthopaedic SurgeryMount Sinai Medical Center, 5 East 98 Street, 9th FloorNew York, NY 10029
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15
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A promising new technique for closed reduction of arytenoid dislocation. The Journal of Laryngology & Otology 2011; 126:168-74. [DOI: 10.1017/s002221511100226x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractObjectives:To study the effect of a new technique for closed reduction of dislocated arytenoids.Methods:The study included 21 females (72.4 per cent) and eight males (27.6 per cent) with a diagnosis of arytenoid dislocation. There were 18 cases of left arytenoid dislocation and 11 of right arytenoid dislocation.Twenty-eight cases had anteromedial dislocation and one had posterolateral dislocation. All patients were treated with closed reduction using custom-made metal rods and an operating microscope, under general anaesthesia.Results:Post-operatively, 21 patients’ voices returned completely to normal (including full vocal fold mobility), five had an improved voice and three failed to show any improvement. There were no post-operative complications.Conclusion:This new closed reduction technique is a safe procedure for patients with dislocated arytenoids. It is repeatable and the outcome is reliable and effective. Closed reduction can be a useful treatment for arytenoid dislocation.
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16
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Using the inflating syringe as a safety valve to limit laryngeal mask airway cuff pressure. J Clin Monit Comput 2011; 25:405-10. [DOI: 10.1007/s10877-011-9319-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022]
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17
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Norris BK, Schweinfurth JM. Arytenoid dislocation: An analysis of the contemporary literature. Laryngoscope 2011; 121:142-6. [PMID: 21181984 DOI: 10.1002/lary.21276] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS To discuss the incidence, diagnosis, laryngeal findings, and management of arytenoid dislocation as a separate entity from vocal fold paralysis. STUDY DESIGN Literature review. METHODS A contemporary review of the literature was performed by searching the terms arytenoid cartilage dislocation and subluxation in various combinations. Articles were analyzed and selected based on relevance and content. RESULTS Arytenoid dislocation is described as an uncommon laryngeal finding associated with intubation or blunt laryngeal trauma. The majority of recent publications are case reports or small case series. Diagnosis of arytenoid dislocation with flexible laryngoscopy, helical computed tomography, videostroboscopy, and laryngeal electromyography is recommended. In most reported cases, diagnosis has been made based on the position of the arytenoid at laryngoscopy. Reduction and repositioning of the arytenoid cartilage is reported with limited success noted with delayed diagnosis. Speech therapy may also be a beneficial treatment option. CONCLUSIONS Although arytenoid dislocation is reported in the literature, the body of available evidence fails to sufficiently differentiate it as a separate entity from unilateral vocal fold paralysis. Flexible laryngoscopy is inadequate as a standalone procedure to distinguish arytenoid dislocation from laryngeal nerve injury.
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Affiliation(s)
- Byron K Norris
- Department of Otolaryngology and Communicative Sciences, University of Mississippi, Jackson, Mississippi, USA.
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Tan V, Seevanayagam S. Arytenoid subluxation after a difficult intubation treated successfully with voice therapy. Anaesth Intensive Care 2010; 37:843-6. [PMID: 19775054 DOI: 10.1177/0310057x0903700505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Arytenoid subluxation is a rare laryngeal injury that may follow instrumentation of the airway and present as hoarseness, vocal fatigue, stridor, dysphagia, odynophagia and sore throat. We report the case of an 88-year-old man with type 2 diabetes mellitus who developed this complication during a difficult intubation where a Macintosh laryngoscope and gum elastic bougie were used to facilitate intubation. Previously considered to play a minor role in treatment, voice therapy was used successfully in this patient to correct subluxation of the arytenoid, with prompt resolution of his symptoms.
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Affiliation(s)
- V Tan
- Department of Anaesthesia, The Northern Hospital, Epping, Victoria, Australia
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19
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Laryngomalacia in a 12-year-old child after laryngeal mask use. The Journal of Laryngology & Otology 2009; 123:1042-4. [DOI: 10.1017/s0022215109005325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We present an unusual case of a 12-year-old child with state-dependent laryngomalacia presenting after anaesthesia with a laryngeal mask airway.Method:Current literature on state-dependent laryngomalacia and injury following laryngeal mask use is reviewed.Results:A child who had previously suffered with laryngomalacia as an infant presented with disturbed breathing at night and during exercise. After anaesthesia using a laryngeal mask airway, these symptoms became more pronounced. Microlaryngoscopy revealed laryngomalacic type movement of the larynx.Conclusion:Our case seems to support a more complex, multifactorial aetiology for laryngomalacia, including both the neurological control of the larynx as well as its structure.
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Niwa Y, Nakae A, Ogawa M, Takashina M, Hagihira S, Ueyama H, Mashimo T. Arytenoid dislocation after cardiac surgery. Acta Anaesthesiol Scand 2007; 51:1397-400. [PMID: 17944645 DOI: 10.1111/j.1399-6576.2007.01384.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Occurring most usually as complications of upper aerodigestive tract instrumentation during endotracheal intubation or extubation, arytenoid cartilage dislocation and arytenoid subluxation are uncommon laryngeal injuries. Their precise cause, however, is usually difficult to determine. We encountered arytenoid dislocation following cardiac surgery requiring the use of transesophageal echocardiography (TEE). This case prompted us to review some of the mechanisms of injury to the cricoarytenoid joint. We conclude that even very subtle force may dislocate the arytenoid cartilage. We speculate that careless insertion of a TEE probe is mechanically capable of causing arytenoid dislocation and arytenoid subluxation. As ideal tools for intra-operative cardiovascular monitoring, TEE probes are increasingly being used routinely during cardiovascular surgery. So far, arytenoid cartilage dislocation and subluxation following TEE probe insertion have been reported rarely, but complications caused by TEE may increase in the near future. We wish to emphasize the pathophysiological risks of TEE monitoring and other procedures associated with anesthesia, and the need for a proper explanation to achieve informed consent before carrying out TEE monitoring during cardiac surgeries.
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Affiliation(s)
- Y Niwa
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
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Rontal E, Rontal M. Vocal Cord Paralysis After Laryngeal Mask Airway Ventilation. Laryngoscope 2006; 116:1527-8; author reply 1528. [PMID: 16885768 DOI: 10.1097/01.mlg.0000225977.08118.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Zundert A, Brimacombe J, Kamphuis R, Haanschoten M. The anatomical position of three extraglottic airway devices in patients with clear airways. Anaesthesia 2006; 61:891-5. [PMID: 16922757 DOI: 10.1111/j.1365-2044.2006.04745.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We tested the hypothesis that, in patients with clear airways, the anatomical position of three single-use extraglottic airway devices is similar. The airways studied were: the laryngeal mask airway unique (LMA-U), the Softseal laryngeal mask airway (SS-LM) and the Cobra perilaryngeal airway (Cobra-PLA). Three hundred spontaneously breathing patients were randomly allocated to have their airway managed using one of these three supraglottic airway devices. A rigid endoscope was passed down the airway tube and the following anatomical assessments were made: position of the epiglottis; position of the glottis; and position of the cuff. The epiglottis was more frequently visible with the LMA-U than with the SS-LM (76 vs 57%, p = 0.006) and with the LMA-U than with the Cobra-PLA (76 vs 46%, p < 0.0001). The epiglottis was in contact with the mask aperture bars in 25% of patients, and in 34% of these, the epiglottis was seen to be herniated through the aperture bars. Herniation of the epiglottis through the mask aperture bars occurred more frequently with the Cobra-PLA than the LMA-U (8 vs 3%, p = 0.008). The vocal cords and arytenoids were more frequently visible with the LMA-U and SS-LM than with the Cobra-PLA (both p < 0.006). Herniation of the arytenoids through the mask aperture bars was more frequently seen with the Cobra-PLA than with the LMA-U (8 vs 0%, p = 0.004). The position of the cuff was optimal for the LMA-U and SS-LM in 90% and 93% of patients, respectively. The cuff was more frequently in the midline with the LMA-U than with the SS-LM (p = 0.002). We conclude that the anatomical position of the LMA-U and SS-LMA is superior to that of the Cobra-PLA in patients with clear airways. The mask aperture bars probably have no anatomical utility and predispose to herniation of the pharyngeal structures.
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Affiliation(s)
- A van Zundert
- Deparmtent of Anaesthesiology, Intensive Care and Pain Therapy, Catharina, Hospital--Brabant Medical School, Eindhoven, The Netherlands
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Banchereau F, Delaunay F, Hervé Y, Torrielli R, Cros AM. [Oropharyngeal ulcers following anaesthesia with the laryngeal tube S]. ACTA ACUST UNITED AC 2006; 25:884-7. [PMID: 16859882 DOI: 10.1016/j.annfar.2006.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 04/19/2006] [Indexed: 11/23/2022]
Abstract
We report a case of acute tongue and uvula ulcerations consecutive to the use of a laryngeal tube Sonda (LTS) for airway management. The LTS was used during general anaesthesia for hysteroscopy and resection of endometrial hyperplasia. No trouble occurred during LTS insertion and anaesthesia. Symptomatic treatment provided complete resolution within a few days. This event points out the potential risk of more serious lesions.
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Affiliation(s)
- F Banchereau
- Département d'Anesthésie-Réanimation IV, Université Victor-Segalen-Bordeaux-II, Hôpital Pellegrin-Enfants, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Dhanasekar G, Sadri M, Mohan S, Young K, Leiberman J. Blunt laryngeal trauma resulting in arytenoid dislocation and dysphonia. Auris Nasus Larynx 2006; 33:75-8. [PMID: 16169177 DOI: 10.1016/j.anl.2005.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Revised: 05/30/2005] [Accepted: 07/22/2005] [Indexed: 11/30/2022]
Abstract
We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequent large granuloma formation resulting in dysphonia and stridor. The patient underwent emergency excision of the obstructive granuloma and speech therapy was started post-operatively. A few weeks after surgery, the granuloma started to recur and laryngeal manipulation by a specialist osteopath was performed. A few weeks after the conservative management, the recurred granuloma resolved completely and patient's voice improved remarkably. Dislocation of the arytenoid cartilage due to blunt trauma is relatively rare and a consequent spontaneous granuloma formation has not been reported so far in the literature. This is also the first report about efficacy of speech therapy combined with laryngeal manipulation in the management of the arytenoid dislocation and the subsequent laryngeal granuloma.
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Mikuni I, Suzuki A, Takahata O, Fujita S, Otomo S, Iwasaki H. Arytenoid cartilage dislocation caused by a double-lumen endobronchial tube. Br J Anaesth 2005; 96:136-8. [PMID: 16311281 DOI: 10.1093/bja/aei281] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Following surgery requiring the use of a double-lumen endobronchial tube, a patient immediately complained of persistent severe hoarseness. On the third day after the operation, fibreoptic laryngoscopy revealed posterolateral dislocation of the left arytenoid cartilage. By the sixth day of the operation, a slight improvement was observed in the hoarseness without treatment and a spontaneous recovery of arytenoid cartilage dislocation was expected. The patient did not consent to surgical treatment, and therefore a conservative therapy was selected. Ten weeks after the operation, it was found that the dislocated left arytenoid cartilage had spontaneously repositioned and the patient regained his normal voice. The causes and treatment options are discussed.
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Affiliation(s)
- I Mikuni
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical College, Asahikawa, Japan.
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Brimacombe J, Clarke G, Keller C. Lingual nerve injury associated with the ProSeal laryngeal mask airway: a case report and review of the literature. Br J Anaesth 2005; 95:420-3. [PMID: 16006489 DOI: 10.1093/bja/aei187] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a case of lingual nerve injury that was associated with use of the ProSeal laryngeal mask airway during shoulder replacement in a 61-yr-old male. We also review other cases of cranial nerve injury, most of which were associated with use of the classic laryngeal mask airway. In principle, the frequency of cranial nerve injuries can be reduced by avoiding insertion trauma, using appropriate sizes, minimizing cuff volume, and early identification and correction of malposition.
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Affiliation(s)
- J Brimacombe
- Department of Anaesthesia and Intensive Care, Cairns Base Hospital, Cairns, Queensland, Australia.
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Shulman GB, Connelly NR. Bilateral pneumothoraces in a pediatric patient undergoing Hickman catheter placement. Anesth Analg 2002; 95:1251-2, table of contents. [PMID: 12401605 DOI: 10.1097/00000539-200211000-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPLICATIONS The laryngeal mask airway (LMA) is often used for airway management in pediatric patients. We report bilateral pneumothoraces in a patient who underwent neck surgery whose airway was managed with a LMA. We recommend that the LMA be used with caution in small children undergoing deep-neck dissection.
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Affiliation(s)
- G Brent Shulman
- Department of Anesthesiology, Marshfield Clinic, Marshfield, WI, USA
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Kaylie DM, Wax MK. Unilateral supraglottic edema after the use of a laryngeal mask airway. Otolaryngol Head Neck Surg 2002; 126:583-4. [PMID: 12075236 DOI: 10.1067/mhn.2002.124434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- David M Kaylie
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97201, USA
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Abstract
Arytenoid dislocation (AD) involves either a complete disruption of the cricoarytenoid joint or a malpositioning of the arytenoid cartilages (AC) with reference to other laryngeal cartilages. In this report, we present a case of AD while using a McCoy laryngoscope. Although McCoy laryngoscope is recognized as a useful option for the cases of difficult endotracheal intubation, we are concerned that AD is likely with this device.
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Affiliation(s)
- T Usui
- Department of Anesthesia, Asahi Chuoh Hospital, Asahi, Chiba, Japan
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Abstract
OBJECTIVE/HYPOTHESIS The combination of intravenous sedation and local infiltration anesthesia is routinely utilized in otologic surgery. Advantages over general anesthesia with endotracheal intubation include ease and speed of induction and emergence, safety, and decreased postoperative discomfort. Anatomic and physiological patient constraints may preclude the use of intravenous sedation and anesthetists inexperienced in this technique may find it difficult to achieve a consistent level of anesthesia appropriate for major otologic surgery. Administration of anesthesia using the laryngeal mask airway (LMA) has been proposed to offer many of the advantages of intravenous sedation with less risk of oversedation and obstructive apnea. STUDY DESIGN A retrospective chart review. METHODS A review of 100 consecutive adult and pediatric patients undergoing major otologic procedures in which the LMA was utilized. RESULTS All laryngeal masks were introduced without a laryngoscope and successful placement was accomplished on the first attempt in 98%. Procedures were performed under spontaneous ventilation and in only one instance was surgery temporarily interrupted because of patient movement. No major complications occurred and no patients required endotracheal intubation. Only three patients complained of mild throat discomfort in the immediate postoperative period. CONCLUSIONS The laryngeal mask airway is a safe and effective means of providing anesthesia during major otologic surgery.
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Affiliation(s)
- B E Duff
- Brown University School of Medicine, Department of Surgery, Rhode Island Hospital, Providence, USA
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Abstract
Sore throat is a common postoperative complaint, occurring most often following tracheal intubation. Factors such as tracheal-tube size and cuff design have been shown to be important causative factors. Routine tracheal intubation for elective surgical procedures can result in pathological changes, trauma and nerve damage which may also account for postoperative throat symptoms. Sore throat following the use of a laryngeal mask appears to be related to the technique of insertion but the contribution of intracuff pressure remains to be clarified. It would appear, however, that high intracuff pressure is associated with nerve palsies due to neuropraxia and nerve compression. Careful insertion techniques for both the tracheal tube and laryngeal mask are of paramount importance in the prevention of airway trauma and postoperative sore throat.
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Affiliation(s)
- F E McHardy
- Northern Schools of Anaesthesia Newcastle, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Rontal E, Rontal M. Botulinum toxin as an adjunct for the treatment of acute anteromedial arytenoid dislocation. Laryngoscope 1999; 109:164-6. [PMID: 9917060 DOI: 10.1097/00005537-199901000-00031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E Rontal
- Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, USA
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Breen PH. An Alternative Way to Remove the Laryngeal Mask Airway "Guide" After Intubation. Anesth Analg 1997. [DOI: 10.1097/00000539-199710000-00051] [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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Brimacombe JR. Arytenoid dislocation and the laryngeal mask airway. Anesth Analg 1997; 85:463. [PMID: 9249132 DOI: 10.1097/00000539-199708000-00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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