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Bronchoscopy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marcus D. Jarboe, James D. Geiger
A moistened swab may be used to protect the upper alveolar ridge in infants. In older children, a Silastic gum guard may be preferred. Direct laryngoscopy is performed using an appropriately sized open laryngoscope with a lateral slot. Once the tip of the laryngoscope is in the vallecula, the larynx is exposed by pulling the epiglottis forward (Figure 4.4). Using the upper alveolus or dentition as a fulcrum should be avoided.
Assessment and Examination of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Jean-Pierre Jeannon, Enyinnaya Ofo
Indirect laryngoscopy examination with a mirror, a technique with an illustrious history,1 is still used as a method of visualizing the larynx. This examination method has several limitations including perceptual errors,2 difficulties in the user reliably recording the side of lesion, the learning curve in acquiring and maintaining the skillset,3 and a significant failure rate which, prior to the era of readily available flexible endoscopy, often mandated direct endoscopy under general anaesthesia.
Adult Anaesthesia
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Daphne A. Varveris, Neil G. Smart
Direct laryngoscopy is performed for diagnostic or therapeutic purposes and may be combined with an examination of the pharynx, oesophagus or bronchial tree. Rigid instruments are used requiring the atlantoaxial joint to be fully extended and so underlying pathology should be excluded. Often, lasers are used to treat isolated lesions of the larynx.
Partial vs full glottic view with CMACTM D blade intubation of airway with simulated cervical spine injury: a randomized controlled trial
Published in Expert Review of Medical Devices, 2023
Chao Chia Cheong, Soon Yiu Ong, Siu Min Lim, Wan Zakaria Wan A., Marzida Mansor, Sook Hui Chaw
Previous report associates higher risk of mucosal injury in hyper angulated blade with reduced space available for tracheal tube advancement [30]. The tip of CMACTM D blade is positioned proximally from vallecula when reducing POGO to <50%, thus create more space to negotiate tracheal tube through glottis. The maneuver should theoretically lower the risk of mucosal trauma. However, the incidence of oral trauma in our study is higher in group POGO< 50% compared to group POGO 100% (42% vs 29%; p = 0.15). All cases of oral trauma in our study were self-limiting mucosal injuries which required no interventions. The higher incidence of mucosal injuries in group POGO < 50% in our study may be attributed to a two steps procedure which involved advancement of the CMACTM D blade tip on the vallecula, followed by withdrawal the of blade dorsally to reduce POGO opening. In addition to difficult video laryngoscopy and tracheal intubation, sore throat and hoarseness of voice may be a complication of laryngology surgery. One patient underwent lingual tonsillectomy in our study but was uneventful. The patients who develop sore throat and hoarseness of voice have complete resolution of symptoms by post operative day three.
A novel puncture needle designed for endoscopic keel placement to treat anterior glottic webs
Published in Acta Oto-Laryngologica, 2021
Jian Chen, Haitao Wu, Peijie He
The tailored puncture needle was designed and modified from a maxillary sinus puncture needle in our hospital, which consisted of a needle, an inner core, and a guide (Figures 1(A) and 2(A)). Specifically, we punctured the anterior neck soft tissues into the endolarynx using the needle at first. The inner core was then withdrawn and replaced by the guide (Figure 1(B,C)). A hook was designed on the edge of the guide and could pull the suture out of the laryngeal cavity (Figure 1(C,D)). The surgical procedures were as follows. The laryngeal cavity was exposed under general anesthesia using the suspension laryngoscopy and surgical microscope. The web was incised using a CO2 laser firstly (Figure 2(B)). A reinforced 0.3 mm-thick silicon keel with a 3–0 polypropylene suture passing along was prepared. The puncture needle with its inner core was then inserted into the subglottic cavity (Figure 2(C)), after which the inner core was removed and the catheter sheath was left in place (Figure 2(D)). The guide was introduced into the laryngeal cavity through the catheter sheath subsequently (Figure 2(E)). The distal suture was caught by the hook of the guide and sent outside through the catheter sheath (Figure 2(F)). The proximal suture above the superior thyroid incisurae was sent out by the same approach (Figure 2(G)). The two sutures were tied and secured externally on the anterior neck over a silicone tube after the keel had been placed correctly (Figure 2(H)).
Predictors of Definitive Airway Sans Hypoxia/Hypotension on First Attempt (DASH-1A) Success in Traumatically Injured Patients Undergoing Prehospital Intubation
Published in Prehospital Emergency Care, 2020
Elizabeth K. Powell, William R. Hinckley, Uwe Stolz, Andrew J. Golden, Amanda Ventura, Jason T. McMullan
From the chart search, 419 subjects were screened for inclusion (Figure 1). Of those screened, 263 subjects met inclusion criteria. The median age was 34 years (IQR 21–50) and 76% were male (Table 1). The mechanism of injury was blunt in 236 (90%) cases, direct laryngoscopy (DL) was used in 225 (86%) of cases, and the majority of subjects (65%) were intubated by a resident physician. The vast majority (92%) of subjects had an intubation attempt in the back of an ambulance. All subjects had some form of pre-oxygenation and 91% had a cervical collar in place during the intubation attempt. Six subjects were excluded for the DASH-1A analysis because they did not have oxygen saturation or blood pressure measurements. A total of 198/263 (75%) subjects had a successful first attempt airway and 142/257 (55%) had a successful DASH-1A airway. Overall, 246 (94%) subjects were able to have an endotracheal tube successfully placed.