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Wang H, Du L, Chen G, Du B, Zhang W, Zheng J. Superior Laryngeal Nerve Block for Microlaryngoscopic Surgery: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:3437-3446. [PMID: 38265181 DOI: 10.1002/lary.31300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/27/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To assess the safety and efficacy of superior laryngeal nerve block (SLNB) for microlaryngoscopic surgery (MLS). DATA SOURCES PubMed, Embase, Web of Science, Ovid Medline, Cochrane Library, CNKI database, VIP database, Wanfang database, and trial registry databases. METHODS PICOS principles were performed: adults undergoing MLS receiving SLNB compared with no-SLNB in randomized controlled trials were included. Primary outcome included the incidence of severe postoperative sore throat (POST). Secondary outcomes included perioperative mean arterial pressure (MAP) and heart rate (HR), incidence of severe postoperative cough, and anesthesia recovery time. RESULTS Eleven articles with 728 patients were included. Results indicated that SLNB provides lower incidence of severe POST in post-extubation 30 min (relative ratio [RR] = 0.13; 95% confidence intervals [CIs]: 0.05 ~ 0.34), 2 h (RR = 0.09; 95% CI: 0.02 ~ 0.36), 4-6 h (RR = 0.11; 95% CI: 0.03 ~ 0.41), and 24 h (RR = 0.15; 95% CI: 0.03 ~ 0.83); lower MAP (tracheal intubation: standardized mean difference [SMD] = -1.59; 95% CI: -1.69 to -0.42); suspension laryngoscope insertion: (SMD = -0.98; 95% CI: -1.49 to -0.46); tracheal extubation: (SMD = -0.78; 95% CI:-1.24 to -0.31); post-extubation 5 min: (SMD = -0.95; 95% CI: -1.41 to -0.49); lower HR (tracheal intubation: mean difference [MD] = -9.71; 95% CI: -17.16 to -2.27); suspension laryngoscope insertion: (MD = -8.64; 95% CI: -16.79 to -0.49); tracheal extubation: (MD = -10.13; 95% CI: -17.86 to -2.39); post-extubation 5 min: (MD = -13.44; 95% CI: -22.53 to -4.35); lower incidence of severe postoperative cough in post-extubation 30 min (RR = 0.18; 95% CI: 0.06 ~ 0.57) and 2 h (RR = 0.13; 95% CI: 0.02 ~ 0.69); and shorter anesthesia recovery time (MD = -5.34; 95% CI: -8.81 to -1.86) compared to controls. CONCLUSIONS SLNB could provide lower incidence of severe POST, more stable perioperative MAP and HR, lower incidence of severe postoperative cough, and shorter anesthesia recovery time for MLS. LEVEL OF EVIDENCE I Laryngoscope, 134:3437-3446, 2024.
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Affiliation(s)
- Huaiming Wang
- Department of Anesthesiology, Sichuan University, West China Hospital, Chengdu, China
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Du
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guo Chen
- Department of Anesthesiology, Sichuan University, West China Hospital, Chengdu, China
| | - Bin Du
- Department of Anesthesiology, Sichuan University, West China Hospital, Chengdu, China
| | - Weiyi Zhang
- Department of Anesthesiology, Sichuan University, West China Hospital, Chengdu, China
| | - Jianqiao Zheng
- Department of Anesthesiology, Sichuan University, West China Hospital, Chengdu, China
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Zhang YY, Zhu S, Yang X, Zhang JX, Liang XS, Zhang S, Guo QL, Huang CS. Esketamine versus Sufentanil Applied Prior to Placement of Suspension Laryngoscope. Laryngoscope 2023; 133:3021-3027. [PMID: 37073819 DOI: 10.1002/lary.30699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/25/2023] [Accepted: 03/21/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE In laryngeal microsurgery, the insertion of the suspension laryngoscope is a strong stimulus that may cause hemodynamic fluctuations and adverse cardiovascular events. The purpose of this study was to compare the effect of preemptive treatment with esketamine and sufentanil on maintaining hemodynamics and reducing the occurrence of adverse cardiovascular events during the insertion of suspension laryngoscope. METHODS In this double-blind randomized controlled trial, patients undergoing general anesthesia for laryngeal microsurgery were randomly assigned (1:1) to esketamine 0.5 mg kg-1 (esketamine group) and sufentanyl 0.125 μg kg-1 (sufentanil group) before inserting the laryngoscope, respectively. RESULTS During the insertion of suspension laryngoscope, the incidence of bradycardia (HR < 60 beats/min) was 39.3% (22/56) in esketamine group, lower than 60.0% (33/55) in sufentanil group (odds ratio [OR], 2.32 [95% CI, 1.11-5.08]; p = 0.029). The incidence of hypotension (MAP <65 mmHg) was 33.9% (19/56) in esketamine group, lower than 56.4% (31/55) in sufentanil group (odds ratio [OR], 2.52 [95% CI, 1.91-5.27]; p = 0.018). The frequency of hypotension in esketamine group was lower than that in sufentanil group (0.36 ± 0.52 vs. 0.56 ± 0.50, p = 0.035). The time-weighted average of HR dropping above 30% of baseline was smaller in esketamine group than in sufentanil group (0.52 ± 2.06 vs. 1.08 ± 2.77, p = 0.006). CONCLUSIONS These findings showed that compared with preemptive treatment of sufentanil (0.125 μg kg-1 ), esketamine (0.5 mg kg-1 ) was effective in reducing the incidence of cardiovascular adverse events, including bradycardia and hypotension induced by the insertion of suspension laryngoscope during the laryngeal microsurgery. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3021-3027, 2023.
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Affiliation(s)
- Yi-Ying Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Sha Zhu
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Xin Yang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Jian-Xi Zhang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Xiao-Shen Liang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Shuai Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
| | - Qu-Lian Guo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
| | - Chang-Sheng Huang
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
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Ellison PR, Statler A, Dragan K, Shepherd J, Chesney JM, Chung J, Fancy T, Ritchie KM, Moore L, Ellison MB. Optimizing Reversal of Muscle Relaxation with Sugammadex to Accelerate Discharge Readiness in Operative Laryngoscopy: A Randomized Clinical Trial. EAR, NOSE & THROAT JOURNAL 2023:1455613221132391. [PMID: 36594162 DOI: 10.1177/01455613221132391] [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: 01/04/2023] Open
Abstract
IMPORTANCE Operative laryngoscopy is a commonly performed ambulatory procedure in patients with significant co-morbidity. Optimal anesthetics for surgical exposure with rapid return to baseline after the procedure enhances postoperative patient safety. OBJECTIVE To determine whether sugammadex hastens recovery in patients undergoing operative laryngoscopy under general anesthesia with rocuronium-induced paralysis. DESIGN Prospective clinical intervention randomized single-blinded, single-center study in an academic tertiary care center. Approved by the institutional review board and registered with ClinicalTrials.gov. SETTINGS Single center tertiary care academic institution. PARTICIPANTS 18 years or older, American Society of Anesthesiology physical status I-III with ability to give written informed consent undergoing operative laryngoscopy. INTERVENTION Participants were randomized into two groups. Both groups received inhaled anesthetic: sevoflurane, remifentanil, and rocuronium at 0.6-1.2 mg/kg for intubation and anti-nausea prophylaxis. Group 1 received reversal with neostigmine (0.04 mg/kg) and glycopyrrolate (0.01 mg/kg). Group 2 received reversal with sugammadex (4 mg/kg). Vital signs were maintained at 20% of baseline in both groups. Post anesthesia care unit nurses were blinded to the reversal agent and were the evaluators of the discharge criteria and times. Primary end point was time to extubation after the procedures and secondary end points were: Subjective interpretation of surgical conditions by the surgeon, hemodynamic, respiratory parameters, anesthetics, and opioids used, operative time, and duration to achieve discharge readiness. RESULTS A total of eighty-four participants, who were similar in age, sex, and weight in both groups. The primary end point and secondary end points were similar except time to meet discharge criteria in the two groups. 65% in the sugammadex versus 35% in the neostigmine group met Aldrete criteria of 18 or higher on arrival at the post anesthesia care unit. CONCLUSIONS Optimizing the anesthetic regimen, along with stable intraoperative hemodynamics and reversal with sugammadex improves discharge readiness in patients undergoing operative laryngoscopy.
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Affiliation(s)
- Pavithra R Ellison
- Medical Center Drive, Morgantown, WV, USA
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
| | - Alec Statler
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
| | - Kristen Dragan
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
| | - Jason Shepherd
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
| | - Jason Mc Chesney
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Tanya Fancy
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Kyle M Ritchie
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
| | - Lucas Moore
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
| | - Matthew B Ellison
- Department of Anesthesiology, West Virginia University, Morgantown, WV, USA
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Ma G, Chen Y, Zhu W, Zheng L, Tang H, Yu Y, Wang L. Evaluating and Visualizing the Contribution of ECG Characteristic Waveforms for PPG-Based Blood Pressure Estimation. MICROMACHINES 2022; 13:1438. [PMID: 36144060 PMCID: PMC9502729 DOI: 10.3390/mi13091438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
Non-invasive continuous blood pressure monitoring is of great significance for the preventing, diagnosing, and treating of cardiovascular diseases (CVDs). Studies have demonstrated that photoplethysmogram (PPG) and electrocardiogram (ECG) signals can effectively and continuously predict blood pressure (BP). However, most of the BP estimation models focus on the waveform features of the PPG signal, while the peak value of R-wave in ECG is only used as a time reference, and few references investigated the ECG waveforms. This paper aims to evaluate the influence of three characteristic waveforms in ECG on the improvement of BP estimation. PPG is the primary signal, and five input combinations are formed by adding ECG, P wave, QRS complex, T wave, and none. We employ five common convolutional neural networks (CNN) to validate the consistency of the contribution. Meanwhile, with the visualization of Gradient-weighted class activation mapping (Grad-CAM), we generate the heat maps and further visualize the distribution of CNN's attention to each waveform of PPG and ECG. The heat maps show that networks pay more attention to the QRS complex and T wave. In the comparison results, the QRS complex and T wave have more contribution to minimizing errors than P wave. By separately adding P wave, QRS complex, and T wave, the average MAE of these networks reaches 7.87 mmHg, 6.57 mmHg, and 6.21 mmHg for systolic blood pressure (SBP), and 4.27 mmHg, 3.65 mmHg, and 3.73 mmHg, respectively, for diastolic blood pressure (DBP). The results of the experiment show that QRS complex and T wave deserves more attention and feature extraction like PPG waveform features in the continuous BP estimation.
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Affiliation(s)
- Gang Ma
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, China Academy of Sciences, Suzhou 215163, China
| | - Yuhang Chen
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, China Academy of Sciences, Suzhou 215163, China
| | - Wenliang Zhu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
- Suzhou Institute of Biomedical Engineering and Technology, China Academy of Sciences, Suzhou 215163, China
| | - Lesong Zheng
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Hui Tang
- School of Electronics and Information Technology, Soochow University, Suzhou 215006, China
| | - Yong Yu
- Suzhou Institute of Biomedical Engineering and Technology, China Academy of Sciences, Suzhou 215163, China
| | - Lirong Wang
- Suzhou Institute of Biomedical Engineering and Technology, China Academy of Sciences, Suzhou 215163, China
- School of Electronics and Information Technology, Soochow University, Suzhou 215006, China
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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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Jindal G, Deshmukh C, Bagal U, Nagare G. Pulse arrival time: Measurement and clinical applications. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_23_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jindal G, Bhat S, Xavier M, Wagh R, Garje K, Nagare G. Poincare plot: A simple and powerful expression of physiological variability. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_88_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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