Laryngeal force sensor metrics are predictive of increased perioperative narcotic requirements

Feng, Allen L.; Ciaramella, Alex; Naunheim, Matthew R.; Gadkaree, Shekhar K.; Fat, Iuliu; Song, Phil Hyun

doi:10.1002/lary.27827

Cited by 7 publications

(10 citation statements)

References 19 publications

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“…Often, the cartilaginous framework of younger patients is soft and malleable, making it difficult to keep in a reduced position. As a result, the significant forces associated with SML 16‐18 may result in disruption of the reduction.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal fractures in professional and semiprofessional ice hockey players

Feng

Parikh

Gadkaree

et al. 2020

Laryngoscope Investig Oto

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Objective: Injuries in professional ice hockey players are common, however significant laryngeal trauma is rare. Here, we present a case series of professional and semiprofessional ice hockey players to demonstrate the mechanism and nature of laryngeal injuries they sustain during play, and to recommend best practices for treatment, prevention, and return to the ice. Methods: A retrospective case review was done of hockey-related laryngeal injuries between 2016 and 2019 at a tertiary laryngology practice. Only semiprofessional and professional hockey players were included. Results: In total, four cases were included. All cases involved trauma from a hockey puck to the neck. No cases were the result of punching, fighting, high sticks or routine checking. Notably, 1 of 4 presented with severe airway compromise, requiring urgent intubation, whereas most presented with pain or a significant voice complaint. Two patients required operative intervention with open reduction and internal fixation of significantly displaced fractures. One patient experienced significant mucosal disruption with cartilaginous exposure at the posterior vocal complex requiring microflap. The average return to ice was 6 weeks for those who required operative intervention and 4 weeks for those who were managed conservatively. One patient had persistent mild dysphonia and all others had a return to baseline phonation. None were wearing neck guards or other protective equipment at the time of injury. Conclusion: Though voice and airway injuries are rarely sustained by ice hockey players, they may require urgent intervention. We recommend that protective equipment be worn and improved to prevent laryngeal trauma.

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Section: Discussionmentioning

confidence: 99%

Laryngeal fractures in professional and semiprofessional ice hockey players

Feng

Parikh

Gadkaree

et al. 2020

Laryngoscope Investig Oto

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“…Prior studies by our group suggest that lower pressures are associated with fewer postoperative complications and a correlation between these forces and postoperative narcotic administration. 4 , 5 The studies also highlight the importance of real‐time monitoring in reducing these complications. This suggests that lower forces exerted by the Mac blade may help minimize postoperative issues compared to the Miller blade.…”

Section: Discussionmentioning

confidence: 99%

“…The poststudy survey was designed on a 5-point Likert scale (1)(2)(3)(4)(5) and asked the experts questions regarding their trial with the experimental device compared to the control. Survey questions include ease of use, realism, willingness to use, and future potential.…”

Section: Survey Metricsmentioning

confidence: 99%

“… 1 , 2 , 3 Previous studies from our group have shown that excessive forces exerted through laryngoscopes during suspension microlaryngoscopy are associated with soft tissue injuries within the oral cavity and other postprocedure complications like pain and neuropathy. 4 , 5 , 6 During intubation, excessive forces have been hypothesized to be a causative factor in postprocedure complications. Little research has been performed to quantify the force needed to cause such symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Design, development, and face validation of an intubation simulation device using real‐time force data feedback

Rao

Juang

et al. 2022

Laryngoscope Investig Oto

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Objectives To develop a novel laryngoscope device capable of dynamically measuring force and torque measurements in real‐time during intubation and to explore the efficacy of such a device through a face validation simulation. Methods The torque sensor laryngoscope is designed for use during intubation and is modeled after a standard, single‐use plastic laryngoscope. After device calibration, a face validation study was performed with intubation experts in the field. Quantitative data (intubation force metrics) and qualitative data (expert feedback on the device) were collected from three intubations using a Mac blade and three intubations with the Miller blade. Results Three experts (two anesthesiologists and one otolaryngologist) participated in the study. The mean maximum force exerted with the Mac blade was 24.5 N (95% confidence interval [CI], 22.3–26.8). The average force exerted was 13.6 N (95% CI, 11.7–15.5). The average total suspension time was 13.1 s (95% CI, 10.4–15.8). The average total impulse was 164.6 N·s (95% CI, 147.9–181.4). The mean maximum force exerted with the Miller blade was 31.6 N (95% CI, 26.4–36.8). The average force exerted was 15.8 N (95% CI, 13.8–17.9). The average total suspension time was 11.3 s (95% CI, 9.9–12.6). The average total impulse was 216.2 N·s (95% CI, 186.5–245.9). The mean maximum force ( p = .0265) and total impulse ( p = .009) were significantly higher in the Miller blade trials than in the Mac blade trials. Survey results found that this device, while bulky, intubated similarly to standard‐use models and has potential as an intubation teaching tool. Conclusion The torque sensor laryngoscope can measure and display real‐time intubation force metrics for multiple laryngoscope blades. Initial validation studies showed a significantly lower maximum force and total impulse when intubating with the Mac blade than with the Miller blade. Face validation survey results were positive and suggested the potential for this device as a teaching tool. Level of Evidence Level 5.

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“…10 These studies also showed complications occurring in over a third of patients and an association between increasing force metrics and perioperative narcotic requirements. 11 However, questions remain regarding the durability of these postoperative issues and whether they could be mitigated. In the current study, we sought to determine if the LFS could not only predict the development of postoperative complications but also help mitigate them through active use of the sensor.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal Force Sensor for Suspension Microlaryngoscopy: A Prospective Controlled Trial

Feng

Puka

Ciaramella

et al. 2021

Otolaryngol.--head neck surg.

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Objectives The laryngeal force sensor (LFS) provides real-time force data for suspension microlaryngoscopy. This study investigates whether active use of the LFS can prevent the development of complications. Study Design Prospective controlled trial. Setting Academic tertiary center. Methods The LFS and custom software were developed to track intraoperative force metrics. A consecutive series of 100 patients had force data collected with operating surgeons blinded to intraoperative readings. The subsequent 100 patients had surgeons actively use the LFS monitoring system. Patients were prospectively enrolled, completing pre- and postoperative surveys to assess the development of tongue pain, paresthesia, paresis, dysgeusia, or dysphagia. Results On univariate analysis, the active monitoring group had lower total impulse ( P < .001) and fewer extralaryngeal complications ( P < .01). On multiple logistic regression, maximum force (odds ratio [OR], 1.08; 95% CI, 1.01-1.16; P = .02) was a significant predictive variable for the development of postoperative complications. Similarly, active LFS monitoring showed a 29.1% (95% CI, 15.7%-42.4%; P < .001) decrease in the likelihood of developing postoperative complications. These effects persisted at the first postoperative visit for maximum force ( P = .04) and active LFS monitoring ( P = .01). Maximum force (OR, 1.11; 95% CI, 1.04-1.18; P < .01) and active LFS monitoring (16.6%; 95% CI, 2.7%-30.5%; P = .02) were also predictive for the development of an abnormal 10-item Eating Assessment Tool score. These effects also persisted at the first postoperative visit for maximum force ( P = .01) and active LFS monitoring ( P = .01). Conclusion Maximum force is predictive of the development postoperative complications. Active monitoring with the LFS is able to mitigate these forces and prevent postoperative complications. Level of Evidence 2.

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Laryngeal force sensor metrics are predictive of increased perioperative narcotic requirements

Cited by 7 publications

References 19 publications

Laryngeal fractures in professional and semiprofessional ice hockey players

Laryngeal fractures in professional and semiprofessional ice hockey players

Design, development, and face validation of an intubation simulation device using real‐time force data feedback

Laryngeal Force Sensor for Suspension Microlaryngoscopy: A Prospective Controlled Trial

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