Laryngeal Irritation Research Articles

Non-pharmacological approaches to chronic cough.

While cough is a protective reflex it can occur in the absence of any physical need to clear the airway. In chronic cough, cough can be triggered by innocuous stimuli and persist despite medical treatment. Non-pharmacological interventions such as cough control therapy, provided by speech pathologists, have gained popularity in recent years. Intervention targets refractory or unexplained chronic cough and efficacy has been studied in randomised controlled trials. Key elements of cough control therapy include education, anticipation and control of the urge to cough, reducing laryngeal irritation and psychoeducational counselling. Our understanding of the mechanisms behind the success of non-pharmacological treatment is developing. It is likely the mechanisms of action are multi-factorial across peripheral, central and higher cortical regions. Non-pharmacological cough control therapy interventions are now included in international cough guidelines. However, approach to service delivery is not standardised and varies between regions and countries.

Stroboscopy while Lifting Weights: A New Assessment Technique for Observing the Larynx in Strength Athletes while Lifting Weights (with and without Valsalva maneuver)

Lifting weights is a popular exercise method for improving the physical characteristics underlying performance in a wide range of sports. In order to perform these lifts safely and efficiently, strength athletes use purposeful holding of breath, strong exhalation against closed vocal cords. These are commonly known as Valsalva Maneuvers (VM) or hard glottis closures to increase core stability and reduce some of the load on the spine, and to facilitate lifting by increasing glottis closure and subsequently increasing intra-thoracic and intra-abdominal pressure. This function may expose athletes to an increased risk of laryngeal irritation or injury due to excessive pressure on the vocal cords during VM performance. Despite extensive weight training exercises in sports, its effects on vocal cords and overall laryngeal health have not yet been systematically studied. This brief methodological report describes how to safely use sports stroboscopy in strength training with weightlifting. This technique was safe and allowed to receive high quality and stable images of the larynx with minimal impact on weightlifting.

Study of the effects of dexmedetomidine on hemodynamic parameters and extubation quality in patients undergoing ENT surgery under general anaesthesia

In ENT surgeries most of the cases are done under general anaesthesia and should be extubated smoothly. If a patient is lightly anesthetised, tracheal and laryngeal irritation can stimulate reflex responses during extubation like bucking, gagging, breath holding, laryngospasm, pulmonary oedema. Alpha 2-Adrenergic agonists are used for their sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilizing properties. We aimed to study the extubation quality and hemodynamic parameters of dexmedetomidine undergoing ENT surgeries under general anaesthesia.This observational study included 100 patients undergoing ENT surgery under general anaesthesia, between 18 to 60yrs. Patients were divided into group P (n=50) and group PD (n=50). A standard general anaesthesia technique according to the Ent operation theatre protocol were followed for all patients. For maintenance group P received inj.Propofol 4mg/kg/hr and group PD received inj. Propofol 4mg/kg/hr and inj. Dexmedetomidine infusion 0.5ug/kg/hr as a standard protocol. Respective infusions were stopped at the start of skin closure. Heart rate, systolic blood pressure and diastolic blood pressure were recorded at the time of extubation and at 1,3,5. minutes till 30 minutes after extubation. Quality of extubation was evaluated using 5-point rating scale (extubation quality score) at extubation.The mean heart rate in the group P was 92/min while in the group PD was 75/min. The mean systolic blood pressure in the group P was 116mmhg while in the group PD was 108mmhg. The mean diastolic blood pressure in the group P was 85mmhg and 67mmhg in group PD (P<0.001). 11 patients of group p got extubation quality score of 2 while 41 cases of group PD got a score of 2(P<0.001).InjDexmedetomidine provides stable hemodynamic parameters during extubation and provides better extubation quality score.

Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge.

Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. We recruited consecutive patients referred for clinical mannitol challenge. The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was administered. Throughout testing, coughs were audio-recorded to derive a cough frequency index per time and dose of mannitol. Relationships between cough indices, laryngeal hypersensitivity and bronchial hyperresponsiveness (BHR) were examined. Participants were classified by cough characteristics with k-means cluster analysis. Of 90 patients who underwent challenge, 83 completed both the questionnaire and challenge. Cough frequency was greater in patients with abnormal laryngeal hypersensitivity (p=0.042), but not in those with BHR. There was a moderate negative correlation between coughs per minute and laryngeal hypersensitivity score (r=-0.315, p=0.004), with lower LHQ scores being abnormal. Cluster analysis identified an older, female-predominant cluster with higher cough frequency and laryngeal hypersensitivity, and a younger, gender-balanced cluster with lower cough frequency and normal laryngeal sensitivity. Cough frequency during mannitol challenge in our cohort reflected laryngeal hypersensitivity rather than BHR. Laryngeal hypersensitivity was more often present among older female patients. With the incorporation of cough indices, mannitol challenge may be useful to test for laryngeal hypersensitivity as well as BHR.

English

BACKGROUND Laryngopharyngeal reflux (LPR) is found to be a common disease encountered in Otolaryngology practice. LPR presents clinically with symptoms of laryngeal irritation, frequent throat clearing, cough, and hoarseness of voice. The main diagnostic methods currently used are Fiber-optic laryngoscopy and in some centers pH monitoring. Proton pump inhibitors (PPIs) are used and found to be cost-effective and useful for the treatment of LPR. The main objective of this study was to study the effectiveness of PPIs in alleviating the symptoms assessed using Reflux Symptom Index (RSI) score and Reflux Finding Scores (RFS). METHODS A prospective study was carried out on 100 patients attending the ENT OPD of Government Medical College and Hospital, Thrissur, Kerala. Patients were evaluated for improvement in symptoms of Laryngopharyngeal reflux disease following use of proton pump inhibitors, using Reflux symptom index and Reflux finding scores using 70 degree / flexible nasopharyngolaryngoscopy. Patients with clinical findings of LPRD with RSI score > 13 and RFS score > 7 were given a standard treatment protocol followed in our ENT department using Tab. Pantoprazole 40 mg twice daily before food and the treatment response was assessed by proper follow up at 6 weeks and 12 weeks. On each follow up visit, improvement in RSI and RFS scores with Proton pump inhibitor therapy was assessed. Data collected was then tabulated and analysed. RESULTS The study was conducted in 100 patients, 59 % of whom were females and 41 % males. Mean RSI score changed from 18.9 at the beginning to 14.5 at 6 weeks of treatment and 9.0 at 12 weeks of treatment with Proton pump inhibitor. Mean RFS score changed from 10.7 at the beginning to 8.7 at 6 weeks of treatment and to 5.9 at 12 weeks of treatment. Comparison of mean Reflux Symptom Index and mean Reflux Finding Scores before and after treatment revealed improvement and the result was statistically significant (p value < 0.001). CONCLUSIONS The use of RSI and RFS scores in the assessment of PPIs at fixed intervals is cost effective and avoids time consuming and cost intensive examinations. These scores also help in early diagnosis and long term follow up of LPR patient. Fixed time interval PPI treatment significantly improved RSI and RFS scores in LPR patients. The mean RSI score changed from 18.9 at the beginning of treatment to 14.5 at 6 weeks after treatment (p value < 0.001) and 9.0 after 12 weeks of treatment; (p value < 0.001) The mean RFS score changed from 10.7 at the beginning of treatment to 8.7 at 6 weeks after treatment (p value < 0.001) and 5.9 after 12 weeks of treatment; (p value < 0.001). KEYWORDS Laryngopharyngeal Reflux, Reflux Symptom Index, Reflux Finding Score

Stellate Ganglion Block for the Treatment of Post-Traumatic Stress Disorder, Depression, and Anxiety


 The evidence regarding the clinical effectiveness of stellate ganglion block for the treatment of post-traumatic stress disorder was mixed. A randomized controlled trial included in a systematic review did not detect significant differences in post-traumatic stress disorder symptoms in the stellate ganglion block versus sham groups, while another randomized controlled trial did detect significantly greater improvements in symptoms between these groups. Furthermore, the second randomized controlled trial detected significantly greater improvements in depression, anxiety, and distress, but not in pain and mental and physical functioning for participants receiving stellate ganglion block compared to sham.
 Authors of the randomized controlled trial included in the systematic review did not detect significant differences in rates of adverse events between groups. Of the 6 adverse events reported in the second randomized controlled trial, 3 were deemed related to stellate ganglion block treatment (injection site pain, self-resolving bradycardia, and temporary laryngeal irritation); the statistical analysis was not reported.
 Authors of 1 evidence-based guideline were unable to provide recommendations for or against the use of stellate ganglion block for the treatment of post-traumatic stress disorder because of insufficient evidence.
 No relevant literature or guidelines regarding the clinical effectiveness or use of stellate ganglion block for the treatment of depression or anxiety were identified.

A Comparative Study of Dexmedetomidine and Fentanyl on Airway Reflexes and Hemodynamic Responses to Tracheal Extubation in Nasal Surgeries

Background: Extubation at light levels of anesthesia or sedation can stimulate reflex responses via tracheal and laryngeal irritation. The present study was conducted to compare dexmedetomidine and fentanyl on airway reflexes and hemodynamic responses to tracheal extubation in nasal surgeries.Subjects and Methods:The present study was conducted on 60 patients of ASA grade I and Grade II of both genders. Patients were divided into 2 groups of 30 each. Group I were dexmedetomidine 0.5 μg/kg in 100 mL of isotonic saline and group II patients received fentanyl 1 μg/kg in 100 mL of isotonic saline intravenously. Parameters such as duration of surgery and duration of anesthesia (minutes) were recorded. Extubation time, awakening time and orientation time was recorded.Results:The ASA grade I was seen in 20 in group I and 14 in group II, ASA grade II was seen in 10 in group I and 16 I group II. Group I comprised of 14 males and 16 females, group II had 17 males and 13 females. Mean duration of surgery in group I was 172.4 minutes and in group II was 174.6 minutes in group II. Mean duration of anesthesia was 194.2 minutes in group I and 198.6 minutes in group II. The difference was non- significant (P> 0.05). The mean extubation time in group I was 7.2 minutes and 5.6 minutes in group II, awakening time was 10.2 minutes in group I and 10.8 minutes in group II and orientation time was 14.3 minutes in group I and 15.2 minutes in group II.Conclusion:Authors found that dexmedetomidine 0.5 μg/kg IV, administered before extubation, was more effective in attenuating airway reflex responses to tracheal extubation as compared with fentanyl 1 μg/kg IV.

Safe Concentration of Benzene Exposure to Worker’s in Gas Station at the Area of Diponegoro University, Semarang

Benzene is one of the aromatic hydrocarbon compounds that are widely used in the industrial sector. Benzene exposure in the work environment has been set a threshold value. Benzene exposure in humans can provide health effects especially disrupting the central nervous system, hematopoietic system, and immune system. Acute effects can include laryngeal irritation, dizziness, pallor, shortness of breath, headache, fatigue, drowsiness, and fainting. While the chronic effects can be cancer. This research is a study with an environmental health risk analysis approach with the aim to assess and make predictions that will occur due to exposure to benzene in public fuel station (SPBU) officers around the area of Diponegoro University, Semarang. The Environmental Health Risk Analysis (ARKL) approach consists of several steps, namely hazard identification, response dose analysis, exposure analysis, and risk characteristics. The results of the measurement of benzene concentrations in gas stations around the Diponegoro University in Semarang at point 1 were 0.38 ppm and at point 2 was 0.51 ppm. So that the concentration is still below the Threshold Value (NAB) according to the Minister of Manpower Regulation Number 5 of 2018. Based on manual calculations for safe limits benzene concentration is obtained 0.08538 mg / m3 or 0.02672 ppm. This means that the highest concentration of benzene in the work environment is 0.51 ppm, with an average body weight of 55.67 kg, height of 159 cm with a working time of 8 hours, and safe concentration so as not to cause a non-carcinogenic risk is 0.08538 mg / m3 or 0.02672 ppm.

Respiratory Laryngeal Dystonia: Characterization and Diagnosis of a Rare Neurogenic Disorder.

Respiratory laryngeal dystonia (RLD) is poorly understood and rarely reported in the literature. Patients have atypical laryngeal movement resulting in airway obstruction. This motion is neurogenic in nature, is constant while awake, nonepisodic, and non-trigger dependent. Given its rarity, it is often misdiagnosed for inducible laryngeal obstruction; however, it is refractory to medical and behavioral management. Although this condition has been addressed in the literature, this report is the largest case series characterizing presenting symptomology, multimodal treatment outcomes, and longitudinal course of these patients, and proposes a set of diagnostic criteria to aid in clinical identification of RLD patients. Our objectives were to characterize RLD clinically and offer diagnostic guidelines to clinicians. A prospective case series with a retrospective analysis at a tertiary referral center. A review of clinical records and videostroboscopic analysis of 16 patients treated for respiratory laryngeal dystonia from October 2005 to October 2018 was performed. Sixteen patients with respiratory laryngeal dystonia were included. The common features of this group were persistent, nonepisodic dyspnea and stridor with laryngoscopic evidence of paradoxical vocal fold motion. Our patients had no structural neurologic abnormalities. These patients typically failed respiratory retraining therapy and medical management of laryngeal irritants. In our series, 100% of patients underwent respiratory retraining therapy, 68.8% received laryngeal botulinum toxin injection, and 31.3% required tracheostomy. RLD is a rare and challenging condition. The disorder can be severely disabling, and treatment options appear limited. A multidisciplinary approach may be helpful. Some patients responded to laryngeal botulinum injection and medical management, whereas others required tracheostomy for symptom control. Laryngoscope, 2020.

Smoking Cessation Improves the Symptoms and the Findings of Laryngeal Irritation.

Smoking is known to increase laryngeal inflammation and laryngopharyngeal reflux (LPR), which cause laryngeal irritation. Thus, the aim of this study is to evaluate the changes in the symptoms and the findings of laryngeal irritation in smokers after a smoking cessation period. The reflux symptom index (RSI) and the reflux finding score (RFS) were used for evaluating the symptoms and findings of laryngeal irritation in smokers. Endoscopic examination of the laryngeal structures for RFS and symptom inquiry for RSI were performed at the beginning of the study and after a 2 months of cigarette cessation period. This study was carried out in 24 volunteers (14 female and 10 male), between the ages of 24 and 62 years. When we compared the results of RSI and RFS that were performed before and after the cigarette cession period, we found that there was a significant improvement both in RSI and in RFS (P < .001 and P < .001, respectively). Also, there was significant correlation between the cigarette smoking period and RFS score that was determined at the beginning of the study (P = .006, r = .54). A significant improvement was found both in RSI and in RFS after smoking cessation period, which might be the evidence of improvement in laryngeal irritation possibly caused by inflammation due to smoking and LPR. A significant positive correlation was found between smoking period and RFS, especially with vocal fold edema and posterior commissure hypertrophy.

An Interdisciplinary Approach to the Management of Vocal Cord Dysfunction in an Elite Female Swimmer: A Case Study

Acute pulmonary disorders are commonplace within the athletic population, with exercise induced bronchoconstriction (EIB), and vocal cord dysfunction (VCD) common diagnoses. VCD is a condition that causes the adduction of the vocal folds during inhalation, causing obstruction at the larynx and thereby a severely impaired sporting performance. VCD can be brought on by laryngeal irritants, emotional and psychological stress and asthma. The gold standard of treatment for VCD centres on an interdisciplinary approach from specialists that often include a respiratory consultant, speech and language therapist (SLT) and a psychologist. The present case study details the interdisciplinary approach to the treatment of an elite female swimmer with VCD with an intervention programme that lasted nine weeks, instigated by a local general practitioner (G.P.) who chose to engage a Sport Psychology Consultant (SPC) due to the sport-specific nature of the psychological stress experienced by the individual. The steps involved in the design of the sport psychology interventions are outlined and the relationship of those interventions to the work of the other specialists is discussed. The 9 week intervention programme was aimed at reducing perfectionist tendencies and competitive state anxiety using a combination of cognitive behavioural therapy (CBT), goal-setting and imagery. Overall, the treatment programme was deemed a success as perfectionism and competitive state anxiety levels reduced over time along with the frequency of VCD occurrence. This case study demonstrates the breadth of roles that can be undertaken by a SPC and raises awareness of a complex respiratory disorder that is not yet fully understood.

Dogma of Extraesophaghgeal Reflux

Laryngopharyngeal reflux (LPR) disease is an extraoesophageal variant of gastro-esophageal reflux disease that can affect the larynx and pharynx. LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs) has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR. Key words: Extraesophageal reflux disease ㆍ Laryngopharyngeal reflux ㆍ Reflux laryngitis 핵심용어: 식도 외 역류질환 ㆍ 인후두 역류 ㆍ 역류성 후두염

Exercise-induced laryngeal obstruction: a common and overlooked cause of exertional breathlessness.

A commonly-encountered clinical scenario in primary care involves an adolescent or young adult, with no past medical history, presenting with wheeze and breathlessness, occurring in association with exercise.1 However, the differential diagnosis for this presentation is broad. Such patients are often diagnosed with exercise-induced asthma and prescribed a short-acting bronchodilator.1 Recently there has been increasing recognition that an alternative diagnosis should be considered,2 specifically a condition termed exercise-induced laryngeal obstruction (EILO), a phenomenon in which closure of the larynx occurs during high-intensity exercise. This narrowing causes a significant reduction in airflow, thereby precipitating breathlessness and wheeze. Some have termed this condition exercise-induced vocal cord dysfunction (VCD), although the narrowing most frequently occurs at a level above the vocal cords (that is, involves supra-glottic structures) and thus EILO is an appropriate descriptor. The reason EILO develops in some individuals is currently unclear. A primary function of the glottis is to defend the airway, and thus the larynx resides in a primed status that favours closure. The larynx is richly innervated and may become hypersensitive upon repeated exposure to laryngeal irritants. Moreover, the forces and pressure change that are manifest across the larynx during intense exercise appear to play a role in precipitating laryngeal closure. Distinguishing between exercise-induced bronchoconstriction and EILO can be diagnostically challenging, particularly in a primary care setting. The aim of this short article is thus not to provide a complete review of EILO, but to highlight pertinent features for focus in a clinic-based assessment, and …

The Role of Pepsin in LPR: Will It Change Our Diagnostic and Therapeutic Approach to the Disease?

Laryngopharyngeal reflux (LPR) is the back flow of gastric contents into the laryngopharynx. It is estimated that this disease affects 20−40 % of the United States population and is commonly encountered by otolaryngologists. Patients with LPR present with symptoms due to chronic laryngeal irritation such as hoarseness and cough. Pepsin, a gastric enzyme, has been shown to be a specific and sensitive biomarker for LPR. Measurement of pepsin in patients with LPR symptoms holds promise as a reliable diagnostic test. Studies have shown that pepsin induces cell damage, inflammation, and neoplastic changes independently of gastric acid in an endocytosis-dependent manner. Thus, pepsin has been proposed as a novel therapeutic target, especially for patients experiencing refractory symptoms on currently available anti-reflux medications. Further research is needed to elucidate the exact role that pepsin plays in inflammatory and neoplastic diseases of the laryngopharynx and to develop pharmacologic agents targeting pepsin.

Percutaneous or surgical tracheotomy when, why, and selection criteria /Perkutan veya cerrahi trakeotomi, ne zaman? neden? ve secim kriterleri

Aim: Tracheotomy is one of the most frequent procedure especially in the intensive care units (ICU). And the major indication is prolonged respiratory support. Tracheotomy is a procedure for patients who need prolonged mechanical ventilation support or airway protection. By this way, the respiratory care and weaning from mechanical ventilatory support become easier and comfortable. Tracheotomy improves patient tolerance, reduces the need for sedation, avoids laryngeal irritation, enhances nursing care, reduces dead space. Among the ICU patients, 8- 24% of all, undergo tracheotomy procedure. This decision is individually based on the risk and benefits of tracheotomy versus prolonged intubation and also the consent of the patient's relations and expected clinical outcomes. But there is stil no consensus about the timing of the procedure. Clasically, the most considered opinion for tracheotomy in patients that are unable to wean from invasive ventilation within 10-14 days of intubation and should be planned under optimal conditions. The tracheotomy range increased over the last decade. But there is stil no consensus about the optimal timing for procedure, criterias for selection of patients, type of technique and timing of decannulation. The most common, traditional method is open surgical approach; performed in the operating room. Percutaneous technique is relatively simple to perform. And has a shorter procedure time. Percutaneous tracheotomy has become a popular, cost-effective, quick, simple and safe alternative to surgical tracheostomy. There is not an optimal tracheostomy, the physician should choose the best technique according to the patient and at the right time.

Investigating the Effects of Smoking on Young Adult Male Voice by Using Multidimensional Methods

Smoking is one of the most common harmful habits in the world, especially common among young adult male population in Turkey. The purpose of this study was to evaluate the effect of smoking on the young adults' male voice using multidimensional voice assessment methods. This is a case-control study. The study included 109 young adult men, 51 nonsmokers and 58 smokers between the ages of 20 and 34years. The voice evaluation protocol consisted of voice handicap index (VHI), maximum phonation time (MPT), and perceptual, acoustic, and videostroboscopic analyses. A statistically significant increase for physical, physiological, and total scores of VHI was found in smokers group (P<0.05). MPT showed significantly lower values among smokers (P<0.05). There were no significant changes in perceptual analysis of voice samples between smoker and nonsmoker groups. There were no significant changes in any of the acoustic parameters between smoker and nonsmoker groups. Results of videostroboscopic analysis showed significant relationships between smoking and increased vocal fold erythema (P<0.05). In addition, significantly asymmetry, amplitude, and periodicity abnormality of vocal fold movements were observed in smoker group during phonation (P<0.05). The results of this study indicate that observable signs of laryngeal irritation and disturbed phonatory physiology occur even in young adults with relatively brief smoking habits. Subjective symptoms of smoking on voice appear to occur earlier than objective findings.

Proton pompa inhibitörlerinin larengofarengeal reflü hastalarında larengeal irritasyon üzerine etkisi

Objective: To evaluate laryngeal irritation before and after treatment using the reflux symptom index (RSI) in patients diagnosed with laryngopharyngeal reflux (LFR). Methods: A total of 30 patients who were diagnosed with LFR after 24 hours of dual-probe pH monitoring were included in the study. RSI was applied to the patients before and after treatment. In evaluating the patients’ symptoms, throat clearing need and post-nasal drainage, which are frequently observed in LFR, were evaluated post-treatment. The patients were followed for 3 months during proton pump inhibitor treatment. Data regarding the patients’ LFR symptoms were obtained after 3 months, and the responses to treatment based on reflux symptom scale scores, post-nasal drainage, and throat clearing need were evaluated and compared with those pre-treatment. Results: The decrease in the RSI for postnasal drainage value was statistically significant after treatment. The decrease in the throat clearing RSI value was statistically significant after treatment. Conclusion: In patients with persistent postnasal drainage and throat clearing need complaints, if no infection source is identified, the patients should be evaluated by 24-hour pH monitorization in terms of LFR, irrespective of the presence or absence of laryngoscopic findings.

English

AIM: Aim of our study to compare the spinal anaesthesia and general anaesthesia in children undergoing surgeries below umbilicus. OBJECTIVE: to assess the patient comfort in pt. with GA and pt. with spinal anaesthesia, the adequate surgical condition, assess the hemodynamic change, assess the post op analgesia and to assess the post op complication. MATERIAL AND METHOD: 60 ASA grade I & II children of either sex, aged 5-12 yrs undergoing elective surgeries for the lower abdominal, perineal and lower limb surgeries were taken. After taking a detailed history, thorough general physical examination, all pertinent investigation were carried out to exclude any systemic disease. Patients were classified randomly into 2 groups (30 patients in each group). Group A: General anesthesia was given. Group P: subarachnoid block was given. Intraoperative monitoring consisted of SPO2, PR, NIBP, RR and assessment of duration of post-operative analgesia. P-value <0.05 consider significant. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery In SAB since less general anaesthetic drug including parental opioid are used the risk and postoperative respiratory depression is minimal. The stress response to surgery is also limited and recovery is fast. Postoperatively complications like sore throat, laryngeal irritation, cough etc. was also less associated with it. CONCLUSION pediatric spinal anesthesia is not only a safe alternative to general anesthesia but often the anesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and flexibility is broken and is now found to be even more cost effective. It is much preferred technique special for common day case surgeries generally performed in the pediatric age group.

Role of Anxiety on Patient Intolerance during Bronchoscopy

Aims: There are no current data about the adverse effects of anxiety on patient intolerance during bronchoscopy.The aim of our study was to assess the correlation between anxiety and patient intolerance during bronchoscopy. Study Design: Retrospective research study Place and Duration of Study: Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, between January 2010 and 2013 March. Methodology: Data from 94 patients were analyzed. The mean age of the patients was 59 years. Bronchoscopy was performed for lung cancer in 54, pulmonary nodules in 26 and pulmonary infiltration in 14 patients. Hospital Anxiety Depression scale was used to appraise the anxiety symptoms. Cytologic examination of bronchoalveolar lavage, and sputum samples were performed in each patient when available. Original Research Article British Journal of Medicine & Medical Research, 4(11): 2171-2180, 2014 2172 Results: The anxiety or fear profile of the patients before bronchoscopy were as follows: dyspnea (78%), malignant disease (74%), nasal, laryngeal or tracheal irritation (70%), bronchoscopic findings (68%), and hemorrhage (42%). Bronchoscopic examination was intolerable in 14 cases while there was great difficulty to perform the procedure in 18 patients. Cytologic analysis revealed severe in 18, moderate in 22, and mild dysplasia in 25 patients while it was normal in 29 subjects. Hospital Anxiety Depression scale was over eight in 33 patients. The scale was over eight in 13 out of 14 patients who were intolerant to bronchoscopy. Cytology revealed severe in one and moderate dysplasia in another patient intolerant to bronchoscopy. Conclusions: Anxiety appears to be the predominant factor for patient intolerance during bronchoscopy. Pulmonary function, atypical or dysplastic cytomorphological changes in sputum or bronchoalveolar lavage cytology did not show correlation with patient performance.

The investigation and management of cough in adults

Cough is the most common reason why patients consult their doctor. An acute cough due to viral upper respiratory tract infection is disruptive to the individual and can lead to a reduction in productivity. Dextromethorphan is one of the most widely used antitussives; however, there is a paucity of evidence to support the use of antitussive medications. In some patients, the cough persists and impacts on health-related quality of life. Cough hypersensitivity syndrome (CHS) is an emerging term for patients with a chronic cough and it recognizes cough reflex hypersensitivity as a key feature. Most patients describe a laryngeal irritation, such as a tickle sensation, also known as laryngeal paraesthesia. The initial management of CHS is to minimize common aggravators, such as airway inflammation, gastro-oesophageal reflux and rhinitis, which may exacerbate a cough. In cases of refractory cough, speech- or physiotherapy-led cough suppression therapies and gabapentin are recommended. There is a pressing need to develop effective antitussive medications that target peripheral and central cough neural pathways.