Application of superior laryngeal nerve block and videolaryngoscope for awake intubation in a patient with severe acute epiglottitis

Inoue, Shunsuke B.; Komasawa, Nobuyasu; Yasuda, K; Minami, Toshiaki

doi:10.1016/j.jclinane.2018.11.002

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…The internal branch provides sensory innervation to the larynx above the vocal folds, which enters the thyrohyoid membrane with the superior laryngeal artery ( 8 ). Blocking the SLN could inhibit the reflexive response caused by foreign body stimulation of the larynx and glottis; thus, superior laryngeal nerve block (SLNB) is frequently applied in awake endotracheal intubation of potentially difficult airways to alleviate patient discomfort and to prevent airway obstruction due to stimulation of the pharynx ( 9 , 10 ). Meanwhile, SLNB or block or transection of its internal branch is a viable therapeutic option for medically refractory neuropathic cough ( 8 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Block of the Internal Branch of the Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Suspension Laryngoscopic Surgery: A Prospective Randomized Trial

et al. 2022

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ObjectiveSuspension laryngoscopy is commonly used in operative laryngology. Although it is efficient and minimally invasive in most cases, it can lead to postoperative sore throat (POST) and cough. Because of intensive stimulation by the rigid metal suspension laryngoscope, procedures must be implemented under general anesthesia. Together, these factors increase the possibility of postoperative complications. Blocking the internal branch of the superior laryngeal nerve (SLN) is useful in inhibiting the endotracheal intubation stress response. Thus, we evaluated the efficacy of ultrasound-guided block of the internal branches of the superior laryngeal nerve to improve postoperative complications.MethodsA total of 64 patients was scheduled for elective laryngeal cancer resection, and suspension laryngoscopic surgery was performed under general anesthesia with a block of the internal branch of the superior laryngeal nerve (group iSLNB, n = 32) and without a block (group C, n = 32). Patients in group iSLNB received ultrasound-guided blocks of the internal branches of superior laryngeal nerve bilaterally (0.2% ropivacaine, 2 ml each side). The primary outcome measures were the incidence and severity of sore throat and cough assessed 0.5, 2, 6, and 24 h after tracheal extubation. The secondary outcome measures were heart rate and mean arterial pressure on arrival in the operating room (T0), at endotracheal intubation (T1), upon insertion of the suspension laryngoscope (T2), 5 min after insertion (T3), at tracheal extubation (T4), and 5 min after extubation (T5). Blood glucose levels were measured at T0, T3, and T5.ResultsThe incidence and severity of POST and cough in the iSLNB (internal branch of superior laryngeal nerve block) group were significantly reduced within 6 h after extubation compared with those in the control group, regardless of whether swallowing was present (P < 0.05). Compared to the control group from T0–T5, except at T0, the iSLNB group had significantly lower heart rate and mean arterial pressure (P < 0.05). Compared to T0, at other time points, the heart rates in the control group were significantly increased (P < 0.05), and the mean arterial pressures at other time points in the iSLNB group were significantly lower than those at T0 (P < 0.05). The blood glucose levels at T3 and T5 in the iSLNB group were significantly reduced compared with those in the control group (P < 0.05).ConclusionUltrasound-guided block of the internal branch of the superior laryngeal nerve might effectively ameliorate postoperative complications secondary to suspension laryngoscopic surgery with endotracheal intubation under general anesthesia and improve hemodynamic stability.Clinical Trial Registrationhttps://www.chictr.org.cn, identifier: ChiCTR2100049801.

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Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Block of the Internal Branch of the Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Suspension Laryngoscopic Surgery: A Prospective Randomized Trial

et al. 2022

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“…Numerous studies have used superior laryngeal nerve blocks for the cure of neurogenic cough [ 24 , 25 ]. On the other hand, a bilateral block of this nerve has been commonly performed as a part of upper airway preparation for awake intubation [ 8 , 26 ]. The present study showed that US-guided iSLN block helped in attenuating the incidence and severity of POST.…”

Section: Discussionmentioning

confidence: 99%

“…The superior laryngeal nerve is a branch of the vagus nerve, which bifurcates into an internal and external branch, where the internal branch provides sensory innervation of the tongue, epiglottis, and the mucous membrane of the larynx down to the vocal cords [ 7 ]. In general, superior laryngeal nerve blocks with lidocaine have been reported to effectively anesthetize the larynx for airway manipulation and pain management [ 8 , 9 ]. Ramkumar et al have reported that superior laryngeal nerve block as an adjuvant to general anesthesia can provide a better recovery profile of the patients and reduce the occurrence of postoperative cough, sore throat, and hoarseness of voice [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of postoperative ultrasound-guided internal superior laryngeal nerve block on sore throat after intubation of double-lumen bronchial tube: a randomized controlled double-blind trial

et al. 2022

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Background Postoperative sore throat (POST) is one of the main adverse postoperative outcome after tracheal intubation using double-lumen endobronchial tubes (DLTs). The aim of this study was to investigate the effectiveness and safety of ultrasound (US)-guided block of the internal branch of the superior laryngeal nerve (iSLN) for alleviating POST after intubation of DLTs. Methods Patients undergoing thoracic surgery between August 2019 and August 2021 were randomized into two groups depending on whether they received US-guided iSLN block immediately after the operation. In the control group, the patients underwent a thoracic surgery under general anesthesia (GA) with DLTs without any special treatment, while the patients in the experimental group received US-guided iSLN block bilaterally with 2 ml of 0.25% ropivacaine on either side immediately after the operation. The primary outcome was the grading of sore throat at three-time points after the operation, i.e., immediate extubation, 2 h after extubation, and 24 h after extubation. Secondary outcomes included the rate of nausea and vomiting, hoarseness, dyspnea, and choking cough after swallowing saliva at 2 h after extubation. Results The incidence and severity of sore throat were significantly lower in the experimental group than the control group at all time intervals (all P < 0.01). The rate of nausea and vomiting, hoarseness, dyspnea, and choking cough after swallow saliva at 2 h after extubation had no statistical difference (all P > 0.05). Conclusions The use of US-guided iSLN block can be effectively and safely applied to relieve POST after intubation of DLTs on thoracic surgery. Trial registration The study protocol was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, NO. ChiCTR2000032188, 22/04/2020).

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“…After sedation with 1 mg of midazolam, 10 lg of sufentanil, and 0.2 mg glycopyrrolate, we sprayed local anesthetic onto her tongue and epiglottal root via a laryngeal anesthesia tube, then 3 minutes later, we performed an ultrasound-guided bilateral superior laryngeal nerve block. 5 Four milliliters of 2% lidocaine was administered to facilitate an ultrasound-guided cricothyroid membrane puncture, then conscious endotracheal intubation was performed under the guidance of a fiberoptic bronchoscope 3 minutes later. A single-lumen endotracheal tube with an inner diameter of 7 mm was passed smoothly.…”

Section: Case Reportmentioning

confidence: 99%

Management of anesthesia in a patient with osteogenesis imperfecta and multiple fractures: a case report and review of the literature

Wang

Huang

et al. 2021

J Int Med Res

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Patients with osteogenesis imperfecta (OI) usually also show osteoporosis and bone fragility. Because these defects may also be combined with an airway that is difficult to manage, abnormal platelet function, and other problems, the perioperative management of anesthesia represents a substantial challenge. Therefore, it is important to be able to predict the risks during the perioperative period and to formulate and implement specific high-quality anesthesia management plans for such patients when they experience trauma. We report the case of a 59-year-old female patient with OI who experienced trauma resulting in fractures of the left proximal humerus and right hip. She required open reduction and internal fixation of her humerus and total hip arthroplasty. However, she also had obstructive sleep apnea syndrome, and an airway assessment indicated that her airway would be difficult to maintain. General anesthesia combined with a nerve block was administered. An ultrasound-guided bilateral superior laryngeal nerve block and cricothyroid membrane puncture were used to facilitate endotracheal intubation. An ultrasound-guided “hourglass-pattern” fascia iliaca block was performed for perioperative analgesia. The use of a regional block and preparation for the difficult airway access represented important and successful aspects of the management of anesthesia in this patient.

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Application of superior laryngeal nerve block and videolaryngoscope for awake intubation in a patient with severe acute epiglottitis

Cited by 8 publications

References 4 publications

Ultrasound-Guided Block of the Internal Branch of the Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Suspension Laryngoscopic Surgery: A Prospective Randomized Trial

Ultrasound-Guided Block of the Internal Branch of the Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Suspension Laryngoscopic Surgery: A Prospective Randomized Trial

Effect of postoperative ultrasound-guided internal superior laryngeal nerve block on sore throat after intubation of double-lumen bronchial tube: a randomized controlled double-blind trial

Management of anesthesia in a patient with osteogenesis imperfecta and multiple fractures: a case report and review of the literature

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