Laryngeal Morbidity and Quality of Tracheal Intubation

Mencke, Thomas; Echternach, Matthias; Kleinschmidt, S.; Lux, Philip; Barth, Volker; Plinkert, Peter K.; Fuchs‐Buder, Thomas

doi:10.1097/00000542-200305000-00005

Cited by 395 publications

(304 citation statements)

References 40 publications

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“…The overall incidence of SLI at nasofibroscopic examination was low (less than 2%) and comparable to that reported by Baillard et al 1 These results contrast with the much higher incidence of vocal cord sequelae, reaching 42% in non-relaxed patients as previously reported by Mencke et al 5 These authors performed systematic examination of the vocal cords, before and after each anesthetic. For our study, we considered it to be more relevant to assess the incidence of SLI, rather than to record the overall rate of laryngeal sequelae, including non-symptomatic injuries.…”

Section: Discussionsupporting

confidence: 86%

“…Therefore, we chose to perform nasofibroscopic examination, only for those patients who were continuing to suffer from laryngeal symptoms 48 hr to 30 days after anesthesia. This protocol discrepancy can explain, in part, the lower incidence of laryngeal damage which we report, compared to the observations of Mencke et al 5 Furthermore, the use of smaller tracheal tubes (6.5 and 7 mm), compared to the larger tube sizes used in the study by Mencke et al 5 (7.5 mm for women) may also have contributed to the incidence of laryngeal damage. The size of endotracheal tube contributes significantly to the occurrence of laryngeal morbidity.…”

Section: Discussioncontrasting

confidence: 82%

“…Whereas some authors report similar frequencies of laryngeal morbidity in patients with either excellent or good intubating conditions, [1][2][3][4] others have shown that excellent intubating conditions, provided by the administration of neuromuscular blocking drugs (NMBDs) at induction of anesthesia, are associated with fewer postoperative laryngeal symptoms and less tissue damage than are associated with non-excellent conditions. 5,6 Hence, optimizing intubating conditions by using NMBDs would be required to minimize airway symptoms and injuries related to tracheal intubation. 5,6 However, patient factors may contraindicate the use of NMBDs, and administration of NMBDs may be associated with several potentially serious complications, such as anaphylactic reactions, residual curarization (even after a single intubating dose of NMBD), and awareness during general anesthesia.…”

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

“…5,6 Hence, optimizing intubating conditions by using NMBDs would be required to minimize airway symptoms and injuries related to tracheal intubation. 5,6 However, patient factors may contraindicate the use of NMBDs, and administration of NMBDs may be associated with several potentially serious complications, such as anaphylactic reactions, residual curarization (even after a single intubating dose of NMBD), and awareness during general anesthesia. [7][8][9] Moreover, high rates of good to excellent intubating conditions have been reported without the use of NMBDs, provided that the anesthetic induction protocol is optimized with an adequate dose of an opioid analgesic co-administered with either propofol or thiopental.…”

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

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Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Bouvet

Stoian

Jacquot-Laperrière

et al. 2008

Can J Anesth/J Can Anesth

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Purpose:The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol. Methods:In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 µg·kg -1 iv and propofol 2.5 mg·kg -1 iv, with either cisatracurium 0.15 mg·kg -1 iv (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr.Results: Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003). Conclusion:Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 82%

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

See 2 more Smart Citations

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Bouvet

Stoian

Jacquot-Laperrière

et al. 2008

Can J Anesth/J Can Anesth

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“…Supplementing a propofol-opioid induction regimen with a non-depolarizing agent improves the quality of tracheal intubation and decreases postoperative hoarseness. 17 . It has been previously demonstrated that rocuronium 0.3 mg Á kg -1 with propofol and an opioid allows adequate intubating conditions.…”

Section: Discussionmentioning

confidence: 99%

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Siddik-Sayyid

Taha

Kanazi

et al. 2009

Can J Anesth/J Can Anesth

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Purpose The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine-remifentanil-propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg Á kg -1 ) with intubating conditions 60 s after administering succinylcholine 1.5 mg Á kg -1 . Methods The randomized double-blind study included 184 healthy adult patients scheduled for elective surgery. Anesthesia was induced in all patients with lidocaine 1.5 mg Á kg -1 , remifentanil 2 lg Á kg -1 , and propofol 2 mg Á kg -1 administered over 30 s. In one group, rocuronium 0.3 mg Á kg -1 was administered before the induction sequence, and in the other group, succinylcholine 1.5 mg Á kg -1 was administered after the induction sequence. Laryngoscopy was attempted 90 s after rocuronium administration and 60 s after succinylcholine administration. Intubating conditions were assessed as excellent, good, or poor on the basis of ease of laryngoscopy, position of the vocal cords, and reaction to insertion of the tracheal tube and cuff inflation. Results There were 92 patients per group. In the rocuronium group, intubating conditions were excellent in 83 patients (90%), good in 8 (9%), and poor in 1 (1%), not significantly different from the intubating conditions in the succinylcholine group, which were excellent in 88 patients (96%), good in 3 (3%), and poor in 1 (1%) (P = 0.3). Conclusion During a lidocaine-remifentanil-propofol induction of anesthesia, rocuronium 0.3 mg Á kg -1 administered before the induction sequence provides intubating conditions comparable to those achieved with succinylcholine 1.5 mg Á kg -1 administered after the induction sequence. RésuméObjectif La succinylcholine permet de re´aliser l'intubation trache´ale dans les plus courts de´lais, avec les meilleures conditions d'intubation et la dure´e la plus courte de paralysie musculaire. Au cours d'une induction de l'anesthe´sie avec lidocaı¨ne-re´mifentanil-propofol, nous avons compare´les conditions d'intubation 90 sec apre`s avoir administre´du rocuronium a`faible dose (0,3 mgÁkg -1 ) aux conditions d'intubation 60 sec apre`s avoir administre´de la succinylcholine a`1,5 mgÁkg -1 . Méthode Au total, 184 patients adultes sains devant subir une chirurgie non urgente ont pris part a`cette e´tude randomise´e en double aveugle. L'anesthe´sie a e´te´induite chez tous les patients avec de la lidocaı¨ne (1,5 mgÁkg -1 ), du re´mifentanil (2 lgÁkg -1 ) et du propofol (2 mgÁkg -1 ) administre´s sur une pe´riode de 30 sec. Dans un groupe, du rocuronium (0,3 mgÁkg -1 ) a éte´administre´avant la

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Adverse Laryngeal Effects Following Short-term General Anesthesia<subtitle>A Systematic Review</subtitle>

Mendels

Brunings²,

Hamaekers³

et al. 2012

Arch Otolaryngol Head Neck Surg

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Hoarseness and vocal cord injuries are clinically relevant complications related to short-term general anesthesia using an endotracheal tube or laryngeal mask. However, more well-designed prospective studies are necessary to generate reliable data as well as to investigate techniques to reduce adverse laryngeal effects. For future research, a proposal to categorize the vocal cord lesions due to general anesthesia is presented. Furthermore, use of a preoperative and postoperative standardized measurement protocol using acoustic analysis and the Voice Handicap Index is advised.

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Laryngeal Morbidity and Quality of Tracheal Intubation

Cited by 395 publications

References 40 publications

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Excellent intubating conditions with remifentanil–propofol and either low-dose rocuronium or succinylcholine

Adverse Laryngeal Effects Following Short-term General Anesthesia<subtitle>A Systematic Review</subtitle>

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