Foreign Bodies ; Glottis ; Humans

PURPOSE: The purpose of this study is to compare the effectiveness of the GlideRite with the conventional-malleable-stylet (CMS) in endotracheal intubation (ETI) using the Macintosh-laryngoscope. METHODS: This study is a randomized crossover simulation study. Participants performed ETI using both the GlideRite and the CMS in the normal airway and in a tongue edema (simulated difficult airway resulting in lower percentage of glottis opening [POGO]) model. RESULTS: In both the normal and the tongue edema models, all 36 participants performed ETI successfully using the two stylets on the first attempt. In the normal airway model, there was no difference in time required for ETI (T(ETI)) or ease of handling between the two stylets. In the tongue edema model, the T(ETI) increased as POGO score decreased with the CMS (POGO score showing negative correlation with T(ETI) for the CMS, Spearman's rho=-0.518, p=0.001) but not for the GlideRite (rho=-0.208, p=0.224). The T(ETI) was shorter with the GlideRite than the CMS, but without statistical significance (15.1 vs. 18.8 seconds, p=0.385). Ease of handling was superior with the GlideRite compared to the CMS (p=0.006). CONCLUSION: Performance of the GlideRite and the CMS was not different in the normal airway model. However, in the simulated difficult airway model with a low POGO score, the GlideRite performed better than the CMS for direct laryngoscopic intubation.
Edema ; Glottis ; Intubation ; Intubation, Intratracheal* ; Tongue

Hiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups that are caused by gastric distention, spicy foods and neural dysfunction can resolve themselves without any treatment. Some hiccups are associated with certain diseases or they occur postsurgically, and life-restricting intractable hiccups should be treated. The cause of hiccups should be quickly determined so as to administer the proper treatment. Hiccups often remit spontaneously within a short period of time, but they may also occur without remission for a prolonged period in some cases. We report here on a 36-year-old man who suffered with intractable hiccups for 5 years. We administered a single oral dose of baclofen, and then the hiccups disappeared. We conclude that a single dose of baclofen is a good treatment for intractable hiccups.
Adult ; Baclofen ; Diaphragm ; Glottis ; Hiccup ; Humans ; Spasm

Foreign Bodies ; diagnosis ; Glottis ; Humans ; Infant

Glottis ; pathology ; Humans ; Laryngeal Diseases ; surgery ; Stents

Hiccup is caused by synchronous contractions of the diaphragmatic and intercostal muscles followed by the closure of the glottis. Intractable hiccup is defined as hiccup bouts lasting more than 48 hours or recurring despite various treatments. Recently we have experienced a case of postoperative intractable hiccup. We failed to stop intractable hiccup by pharmacological treatment, but succeeded by unilateral phrenic nerve block.
Glottis ; Hiccup* ; Humans ; Intercostal Muscles ; Nerve Block ; Phrenic Nerve*

Laryngeal mask airways (LMAs) have several advantages compared with conventional endotracheal tube (ETT) in tracheal surgery. LMAs cannot penetrate the airway below the level of the glottis, but enable the access to the larynx and tracheobronchial tree while avoiding airflow impairment, tracheal stimulation, trauma, and the interference of tracheal mucosal blood flow. Moreover, LMAs have lower airway resistance than ETTs. We describe the use of a proseal laryngeal mask airway (PLMA) in patients with high grade upper tracheal stenosis. We suggest that PLMA might have advantages over the classic LMA by preventing aspiration and by allowing the evacuation of air from the stomach in high-grade upper tracheal stenosis.
Airway Resistance ; Glottis ; Humans ; Laryngeal Masks* ; Larynx ; Stomach ; Tracheal Stenosis*

Intubation of an double-lumen endotracheal tube (DLT) in either a normal or a difficult airway may be more difficult than the intubation of a single-lumen endotracheal tube (ETT). A 72-year-old man undergoing right upper lobectomy could not be intubated with either a 37 Fr or a 35 Fr DLT after induction of anesthesia due to an inability to visualize the glottis. Difficult intubation had not been foreseen, but inspection through the laryngoscope revealed a Cormack grade III condition. Following two attempts to place the DLT, fibroptic bronchoscopy also proved unsuccessful. We intubated a 8.0 mm ETT with OELM (optimal external laryngeal manipulation) and followed this by inserting an infusion set catheter into the ETT as a guiding stylet. The ETT was then withdrawn with the catheter in situ in the trachea, and a 35 Fr DLT successfully introduced. After removing the catheter, the position of the DLT was corrected by fibroptic bronchoscopy. No further complication occurred and surgery was finished satisfactory. We achieved successful DLT intubation using the modified Seldinger technique with an infusion set catheter through an intubated ETT in a patient with an unanticipated difficult airway.
Aged ; Anesthesia ; Bronchoscopy ; Catheters ; Glottis ; Humans ; Intubation* ; Laryngoscopes ; Trachea

Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope(R) Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, we were unable to further enter the area using the bronchoscope. Alternatively, we attempted to expose the glottis by GVL blade and then successfully intubated the patient by manually pressing the cricoids cartilage. GVL is nonetheless an excellent instrument in airway management compared to fiberoptic bronchoscope for patients with a huge and fixed supraglottic mass.
Airway Management ; Anesthesia ; Bronchoscopes ; Cartilage ; Glottis ; Humans ; Intubation ; Lidocaine ; Piperidines

PURPOSE: The most important function of the larynx is airway protection which is provided through a polysynaptic reflex closure triggered by the receptors in the glottic and supraglottic mucosa, evoking the reflex contraction of the laryngeal muscles especially by strong adduction of vocal cords. Based on the hypotheses that central facilitation is essential for this bilateral adductor reflex and that its disturbance can result in weakened laryngeal closure, we designed this study to elucidate the effect of central facilitation on this protective reflex. MATERIALS AND METHODS: Seven adult, 20 kg mongrel dogs underwent evoked response laryngeal electromyography under 0.5 to 1.0 MAC (minimum alveolar concentration) isoflurane anesthesia. The internal branch of the superior laryngeal nerve was stimulated through bipolar platinum-iridium electrodes, and recording electrodes were positioned in the ipsilateral and contralateral thyroarytenoid muscles. RESULTS: Ipsilateral reflex closure was consistantly recorded regardless of anesthetic levels. However, contralateral reflex responses disappeared as anesthetic levels were deepened. Additionally, late responses (R2) were detected in one animal at lower level of anesthesia. CONCLUSIONS: Deepened level of anesthesia affects central facilitation and results in the loss of the crossed adductor reflex, predisposing to a weakened glottic closure response. Precise understanding of this effect may possibly provide a way to prevent aspiration in unconscious patients.
Anesthesia/methods ; Animals ; Dogs ; Glottis/*physiology ; Laryngeal Nerves/physiology ; *Reflex