Laryngospasm Research Articles

Evaluation of propofol-based procedural sedation in pediatric hemato-oncological patients provided by physician assistants in anesthesia.

Procedural sedation and analgesia are required for painful hemato-oncological procedures such as lumbar and bone marrow punctures. At our institution, sedation with propofol and alfentanil is usually provided by Physician Assistants in Anesthesia. We evaluated the adverse events during the PSA program for children, provided by Physician Assistants in Anesthesia. We included pediatric patients meeting our criteria for deep sedation by a Physician Assistants in Anesthesia, scheduled for a hemato-oncological procedure at the Amalia Children's Hospital at the Radboudumc Nijmegen. The primary outcome was oxygen desaturation below 92% for more than 20 s. We prospectively collected data on demographics, current health problems, type of procedure, need for airway interventions, and hypotension. We collected data from 437 sedation sessions involving 71 patients. No oxygen desaturation below 92% lasting longer than 20 s occurred. In 2 cases, a jaw thrust was performed. No invasive airway techniques (oropharyngeal cannula, laryngeal mask, or intubation) were required. A significant drop in mean arterial pressure was seen in 2 out of 437 cases (0.5%). There was no occurrence of cardiopulmonary resuscitation or other adverse events such as aspiration or laryngeal spasm. Sedation and analgesia for short painful procedures in selected pediatric hemato-oncological units with a dedicated protocol may be safely provided by trained and certified Physician Assistants in Anesthesia.

Safety of propofol-assisted deep extubation in the dental treatment of children—a retrospective, observational study

PurposeAwake extubation and deep extubation are commonly used anesthesia techniques. In this study, the safety of propofol-assisted deep extubation in the dental treatment of children was assessed.Materials and methodsChildren with severe caries who received dental treatment under general anesthesia and deep extubation between January 2017 and June 2023 were included in this study. Data were collected on the following variables: details and time of anesthesia, perioperative vital signs, and incidence of postoperative complications. The incidence of laryngeal spasm (LS) was considered to be the primary observation indicator.ResultsThe perioperative data obtained from 195 children undergoing dental treatment was reviewed. The median age was 4.2 years (range: 2.3 to 9.6 years), and the average duration of anesthesia was 2.56 h (range 1 to 4.5 h). During intubation with a videoscope, purulent mucus was found in the pharyngeal cavity of seven children (3.6%); LS occurred in five of them (2.6%), and one child developed a fever (T = 37.8 °C) after discharge. Five children (2.6%) experienced emergence agitation (EA) in the recovery room. Also, 13 children (6.7%) experienced epistaxis; 10 had a mild experience and three had a moderate experience. No cases of airway obstruction (AO) and hypoxemia were recorded. The time to open eyes (TOE) was 16.3 ± 7.2 min. The incidence rate of complications was 23/195 (11.8%). Emergency tracheal reintubation was not required. Patients with mild upper respiratory tract infections showed a significantly higher incidence of complications (P < 0.001).ConclusionsPropofol-assisted deep extubation is a suitable technique that can be used for pediatric patients who exhibited non-cooperation in the outpatient setting. Epistaxis represents the most frequently encountered complication. Preoperative upper respiratory tract infection significantly increases the risk of complications. The occurrence of EA was notably lower than reported in other studies.

Anesthesia management for a child with the Koolen-de Vries syndrome: a case report

BackgroundThe Koolen-de Vries syndrome (KdVS) is a relatively new rare disease caused by micro-deletion of 17q21.31 which was first reported by Koolen in 2006. Typical phenotypes for KdVS include hypotonia, developmental delay, moderate intellectual disability, and characteristic facial dysmorphism. Up to now, there was only one case report about anesthesia management of patient diagnosed KdVS. It was a 2-year-old girl who experienced an MRI exam under anesthesia.Case presentationWe described a 21-month-old boy who planned to undergo an orchidopexy under general anesthesia diagnosed with KdVS. He had an intellectual disability, characteristic facial dysmorphism, tracheo/laryngomalacia, patent foramen ovale, and cryptorchidism related to KdVS. Due to the complex condition especially the presence of tracheo/laryngomalacia, we took some special measures, including reducing the amount of long-acting opioid, keeping the spontaneous breath, performing a caudal block, and applying the laryngeal mask. But the laryngeal mask was changed to an endotracheal tube because it failed to provide adequate ventilation. The boy experienced mild laryngeal spasm and hypoxia after extubation, but lateral position and etomidate eased his breathing problem and re-intubation was avoided. It is indicated that anesthesia management for patients with orphan disease is a real challenge for all anesthesia providers.ConclusionsThe Koolen-de Vries syndrome is a relatively new orphan disease involving multiple systems. Keeping spontaneous breath, evaluating airway potency to anesthetics, applying endotracheal tube, and post-extubation lateral or prone position may be helpful for airway management for patient with hypotonia and tracheo/laryngomalacia. KdVS patient needs prolonged post-anesthesia monitoring and/or medication for airway complications.

Severe hypocalcemia, an atypical presentation after thyroid cancer surgery, about a case

Hypoparathyroidism, secondary to postoperative thyroid cancer, is characterized by hypocalcemia, hyperphosphatemia, and hypercalciuria due to low concentrations of parathyroid hormone. The prevalence in the United States is 23 to 37 cases/100,000 people/year. Complications develop in 78 % of cases after cervical surgery; 75 % resolve spontaneously in the first 6 months, while the remaining 25 % resolve permanently; no incidence data were obtained in Bolivia. Treatment requires long-term oral calcium with citrate, calcium carbonate, and vitamin D analogs (calcitriol and alfacalcidol); in complex cases, calcium can be used intravenously (calcium gluconate); Some patients do not respond to standard treatment. In this way, the unusual clinical case of a 38-year-old male patient with a history of papillary thyroid carcinoma, post-total thyroidectomy, with a clinical picture of 48 hours of evolution characterized by pain at the cervical level, associated with a Trosseau sign, is presented. (+) and frank signs of respiratory distress with laryngeal spasm, which required management in the intensive care unit (ICU), correction of severe hypocalcemia, with calcium gluconate IV and calcium plus vitamin D PO; presenting an optimal evolution, graduating on the fourth day; He was subsequently discharged from the hospital two weeks later in good general condition.

Retrospective study of tetanus in 18 dogs-Causes, management, complications, and immunological status.

Tetanus is a severe neurologic disease caused by Clostridium tetani, resulting in spastic paralysis. Canine tetanus is associated with serious complications such as aspiration and a high mortality rate of up to 50%. Medical records of all dogs diagnosed with tetanus over 8 years (2014-2022) were analyzed for severity grade, treatment protocols, nutritional management, and complications, as well as outcome, vaccination, and antibody production in some dogs. No medical records were excluded. Normality was analyzed by the D'Agostino-Pearson test. Parametric, normally distributed data were presented as mean ± standard deviation. Non-parametric, non-normally distributed data were presented as median (m) and range (minimum-maximum). The association between tetanus grade, progression of diseases, and duration of hospitalization was analyzed using the t-test, Mann-Whitney U test, and Kruskal-Wallis test. A P ≤ 0.05 was considered significant. Eighteen dogs were identified. Most affected dogs were classified into severity grade II (66.7%, 12 of 18). Clinical signs deteriorated in 55.6% of dogs (10 of 18). A source was identified in 88.9% of dogs (16 of 18). Nine dogs required surgical wound revision. A percutaneous endoscopic gastropexy tube was placed in 83.3% of dogs (15 of 18) for nutritional support. Medical treatment included metronidazole, methocarbamol, and combinations of different sedatives adapted to the patient's requirements. Tetanus antitoxin was used in 72.2% of dogs (13 of 18) without reported adverse events. The survival rate was 88.9% (16 of 18). Complications, such as hypertension, aspiration pneumonia, and laryngeal spasm occurred in 12 of 18 dogs. Median hospitalization time (8 days; range 0-16 days) was associated with the maximum tetanus severity grade (p = 0.022). Rapid eye movement behavior disorder was observed in 72.2% of dogs (13 of 18). In 5 dogs, antibodies were measured after recovery, and in 4 of 5 dogs, no antibodies were detectable despite generalized tetanus disease. Vaccination with tetanus toxoid was performed in five dogs following the disease. In the present study, the mortality rate was lower than previously reported. Tetanus is still a life-threatening disease, but the prognosis may be good if adequate management and monitoring can be ensured.

COMPARISON OF INDUCTION OF GENERAL ANESTHESIA WITH PROPOFOL AND SEVOFLURANE FOREASE OF I GEL INSERTION: A RANDOMISED CONTROLLED TRIAL

Objectives: The aim of this study is to compare the conditions for supraglottic airway device (I Gel) insertion following induction of anesthesia with inhalation of Sevoflurane or intravenous induction with propofol in patients undergoing short surgery (&lt;3 h) and comparison the loss of eye reflex, Hemodynamic parameters, Jaw opening, Ease of insertion, coughing, gagging, laryngeal spasm are taken into consideration. Methods: It is randomized control trial was conducted in the Department of Anaesthesia at Command Hospital (Air Force) Bengaluru after obtaining permission from the Institutional Ethical Committee. A total of 140 patients included in the study with written consent, during the 18-month period between May 2020 and November 2021. Patients were randomized into one of the two groups as group P: Propofol and group S: Sevoflurane for induction of anesthesia. Both groups receive IV Lignocaine (2 mL of 1%) before induction of anesthesia. The grading condition for insertion between the groups were noted and compared using appropriate statistical tool using SPSS v21 operating on windows 10. Results: There was no significant difference in the mean age of patients between propofol group and sevoflurane group. Overall propofol group had the better performance compared to the sevoflurane group. There was higher incidence of repeat administration in the sevoflurane group (2.9%) compared to propofol group (1.4%), which was statistically insignificant. Conclusion: The present study found comparable results for supraglottic airway device (I Gel) following induction of anesthesia with inhalation of Sevoflurane or intravenous induction with Propofol.

A Novel Acoustic Evaluation Method for the Diagnosis of Adductor Spasmodic Dysphonia

Introduction: Adductor spasmodic dysphonia (ADSD) is characterized by involuntary laryngeal muscle spasms. Due to the lack of a quantitative evaluation method, most measurements have demonstrated difficulty in validity and reliability for diagnosing ADSD. This study aimed to establish a novel indicator for ADSD and determine its diagnostic effects. Methods: We investigated 98 voice samples from 49 patients with ADSD and 49 healthy participants. A sustained vowel was recorded by a high-definition audio recorder. Voice samples underwent regular acoustic evaluation and a novel global dimension (GD) method. GD, Jitter, Shimmer, HNR, Frequency shift, and CPPS were measured for both groups. Results: Statistical analysis revealed that the GD method effectively differentiated ADSD patients from healthy participants (p < 0.001, D′>0.8). Subsequent multiclass receiver operating characteristic analysis demonstrated that GD possessed the most significant classification accuracy (area under the curve = 0.988) compared with other acoustic parameters. Conclusion: GD was an effective metric for objective differentiation between ADSD patients and healthy participants. This metric could assist clinicians in the diagnosis of ADSD patients.

0988 Vagal Nerve Stimulation and OSA

Abstract Introduction We present a case of obstructive sleep apnea (OSA) worsened by implantation of a vagal nerve stimulator (VNS). A 22-year-old M with PMH of autism and refractory epilepsy s/p VNS implantation was diagnosed with moderate OSA. His parents noted that his sleep-disordered breathing worsened after VNS implantation. He was started on APAP 4-12 cm H2O. Review of adherence data revealed an elevated residual apnea-hypopnea index (AHI) despite nightly usage. PAP titration study was obtained with improvement of AHI on 16 cm H2O. Despite consequent use of determined pressure settings, residual AHI remained elevated. In consultation with the patient’s neurologist, VNS settings were gradually down titrated. Residual AHI improved and remained low as CPAP settings were subsequently weaned. Report of case(s) The vagus nerve is part of the parasympathetic nervous system. Afferent fibers project to cortical regions involved in seizure activity. Vagal nerve activation leads to desynchrony, thereby decreasing seizure activity.3 VNS, an adjunctive non-pharmacologic treatment of refractory epilepsy, consists of a generator with multiple adjustable settings and a lead connected to the left vagus nerve.1 VNS activation, in conjuction with medical therapy, can lead to decreased seizures. However, VNS may cause complications such as vocal cord dysfunction, laryngeal spasm, and dyspnea.2 In this case, VNS was noted to cause OSA due to increased airway obstruction, though the pathophysiological mechanism behind this has not been clearly delineated. 3 Conclusion Based on current evidence of precipitation or worsening OSA with VNS activation, screening and diagnostic testing for OSA in patients under evaluation for VNS placement should be considered. A multidisciplinary approach between Sleep Medicine and Neurology in conjunction with patient goals can lead to a balanced optimization of both epilepsy and OSA management via adjustments of VNS settings, anti-epileptics, and CPAP. Support (if any) 1. VNS therapy epilepsy. Epilepsy Foundation. https://www.epilepsy.com/sites/default/files/atoms/files/516VNS_VNS_FINAL.pdf. December 20, 2022. 2. Ebben MR, Sethi NK, Conte M, Pollak CP, Labar D. Vagus nerve stimulation, sleep apnea, and CPAP titration. J ClinSleepMed. 2008 Oct 15;4(5):471-3. PMID: 18853706. 3. Parhizgar F, Nugent K, Raj R. Obstructive sleep apnea and respiratory complications associated with vagus nerve stimulators. J ClinSleepMed. 2011 Aug 15;7(4):401-7. doi: 10.5664/JCSM.1204. PMID: 21897779.

Effect of Laryngeal Mask Airway on Image Quality in Pediatric Patients Undergoing Brain Magnetic Resonance Imaging: A Randomized Controlled Trial.

Magnetic resonance imaging (MRI) is highly sensitive to motion, resulting in artifacts and lowering image quality. Laryngeal mask airway (LMA) provides numerous advantages over endotracheal tubes as it reduces laryngospasm, coughing, and the risk of postoperative desaturation. We aimed to compare LMA with oral airway for airway management during brain MRI in terms of reducing motion artifacts, which can improve image quality. This randomized, controlled, double-blind trial was carried out on 40 pediatrics aged 1 - 18 years, American Society of Anesthesiologists (ASA) physical status І and П undergoing brain MRI. Patients were randomized into two equal groups according to the airway method, the control (Guedel oral airway) group and the LMA group. A compatible anesthesia machine was used to provide O2 and sevoflurane 2% - 4%. The mean MRI image quality score was significantly higher in the LMA group than in the control group (26.10 ± 3.97 versus 18.60 ± 5.30, P < 0.001). Mean arterial blood pressure and heart rate were significantly lower in the LMA group than in the control group at all study times except at baseline and immediate post-extubation (P < 0.05). Cough was significantly lower in LMA than in the control group (15% vs. 50%, P = 0.040). Airway complications (sore throat, laryngeal spasm, and bronchospasm), nausea, and vomiting did not have a significantly different between the two groups. Compared to Guedel oral airway, using LMA for airway management in pediatrics undergoing MRI scans improved the image quality with less cough and better hemodynamics.

Complications secondary to endotracheal intubation in dogs and cats: A questionnaire-based survey among veterinary anaesthesiologists

ObjectiveTo investigate anaesthesiologists’ attitudes towards endotracheal intubation and the perceived incidence of complications secondary to endotracheal intubation in dogs and cats. Study designA cross-sectional online questionnaire-based study. MethodsUsing an online questionnaire distributed via electronic mail, the perceived incidence of complications secondary to endotracheal intubation in dogs and cats was investigated. Attitudes towards endotracheal intubation, average caseload and percentage of animals intubated were examined. The study population consisted of Diplomates, Residents, and residency trained members of the American and European Colleges of Veterinary An(a)esthesia and Analgesia. Univariate descriptive statistics were calculated. For each complication, a mean incidence score (MIS) was calculated, ranging from 1 (never) to 5 (always). Additionally, a Wilcoxon signed-rank test and binary regression analyses were performed. A p value ≤ 0.05 was considered significant. ResultsThe overall response rate was 35.1%, with a completion rate of 26.6%. Most dogs and cats undergoing general anaesthesia were intubated. Endotracheal intubation was viewed as an integral part of modern anaesthesia. Significant differences were found in the incidence of 16 of the 24 examined complications between dogs and cats (p ≤ 0.001). The most frequently perceived complications were reported to be cuff leak (MIS 3.20) and coughing during intubation (MIS 3.10) in dogs, and coughing (MIS 3.01) and laryngeal spasm during intubation (MIS 2.91) in cats. Sociodemographic and practice-specific aspects did not appear to play a significant role in the reported incidence of complications. Conclusions and clinical relevanceEndotracheal intubation was considered a state-of-the-art technique by the respondents. It was associated with a perceived low incidence of major complications and more frequent minor ones. Differences between dogs and cats need to be accounted for. Considering the retrospective and self-reporting nature of this survey, true incidences might differ.

Dexmedetomidine decreases stress post-operative in pediatrics

ABSTRACT Introduction Tracheal extubation causes hypertension and tachycardia. These associated hemodynamic changes are due to sympathetic discharge due to epipharyngeal and laryngeal stimulation.(1) Aim of work Dexmedetomidine is an effective sedative and analgesic agent, it helps in opioid sparing and multimodal techniques in pediatric anesthesia and reduces the toxicity of common anesthetics, and it has been approved by the end of 1999 by the FDA for human use for sedation in the intensive care unit (ICU). Dexmedetomidine is notable for its ability to provide sedation without risk of respiratory depression and can provide cooperative or arousable sedation. The aim of this study is to assess the effect of administering dexmedetomidine near the end of surgery versus a control group regarding the change in circulatory reflexes (represented by MAP) and the incidence of adverse events such as cough, laryngeal spasm or desaturation. Study design This study was designed as a prospective randomized controlled study. It was conducted in the Pediatrics orthopedic surgery theatre (Abo El Reesh pediatric Hospital) belonging to Cairo university hospitals on 70 patients divided into two groups 35 patients each and aged from 3–12 years planned for elective isolated limb anomaly correction. Result Dexmedetomidine injection near the end of the operation decreased the stress induced during extubation with almost no change in HR or MAP and less cough score, which indicated smoother extubation. Conclusion Dexmedetomidine is a potent alpha 2 receptor agonist, having analgesic and sedative effects and sparing usage of opioids without compromising respiratory reflexes or attenuating cardiovascular response during extubation.

Low dose of esketamine combined with propofol in painless fibronchoscopy in elderly patients

To explore the effects and safety of low dose of esketamine combined with propofol in elderly patients undergoing fibronchoscopy. Eighty elderly patients who underwent painless fibronchoscopy in our hospital from June 2021 to September 2021 were recruited,and randomly divided into experimental group (esketamine 0.15mg/ kg + propofol 1mg/ kg) and control group (sufentanil 0.1 μg/ kg + propofol 1mg/ kg), with 40 cases in each group. There were significant differences in MAP, HR and SpO2 of T2, T3 and T4 between the experimental and control groups (P < .05). Besides, there were significantly differences on the trend of change between the 2 groups, with a small and relatively stable fluctuation in the experimental group (P < .05). Compared with the control group, the total dosage of propofol in the experimental group was significantly lower, and the number of vasoactive drugs, the incidence of respiratory depression and bronchospasm were significantly lower (P < .05). There was no significant difference in microscopic examination time, wake-up time, visual analogue score, and agitation, mental symptoms, increased secretion, nausea and vomiting, choking cough and laryngeal spasm during awakening period between the 2 groups. The incidence of total adverse reactions in the experimental group were strongly lower than those in control group. (P < .05). Low dose of esketamine combined with propofol can be safely used for fibronchoscopy in elderly patients, with good effects, more stable respiration and circulation, and low incidence of adverse reactions.

Survival in canine tetanus - retrospective analysis of 42 cases (2006-2020).

To define factors associated with survival in dogs with tetanus and to evaluate the prognostic significance of an established severity classification scheme. Medical records of dogs with the clinical diagnosis of tetanus were retrospectively reviewed with regard to signalment, clinical signs, clinicopathological findings on admission, wound characteristics, complications, therapeutic measures, and survival to discharge. Based on the extracted data, dogs were graded according to a previously published 4-class severity scheme. Non-parametric tests were applied for comparisons between survival categories. Forty-two dogs fulfilled inclusion criteria, of which 32 survived. Of 10 non-survivors, 4 died and 6 were euthanised. Non-survivors were more often younger than 2 years of age (6/10 vs. 7/32 dogs, p = 0.023), had shorter duration of specific signs of tetanus (time from onset of typical signs to presentation) (2 vs. 4 days, p = 0.016), were prescribed less often antibiotics prior to presentation (p = 0.006), had higher tetanus severity grade (10/12 dogs in Class III or IV died, p < 0.001), more often received acepromazine (p = 0.009) and atropine (p = 0.012), and more often had hyperthermia (p = 0.005) and respiratory complications (pneumonia, laryngeal spasm; p = 0.008). Wound characteristics, the use of tube feeding, metronidazole, methocarbamol, magnesium and antitoxin were not significantly different between non-survivors and survivors. Young dogs with a rapid course of severe generalized tetanus have a guarded prognosis. The previously described severity classification scheme proved valuable in predicting survival. Prospective multi-center studies are needed to clarify the prognostic significance of age, sedative usage and modified versions of an established classification scheme, including the presence of respiratory complications.

Spectral Aggregate of the High-Passed Fundamental Frequency and Its Relationship to the Primary Acoustic Features of Adductor Laryngeal Dystonia.

Currently, no clinically feasible objective measures exist that are specific to the signs of adductor laryngeal dystonia (LD), deterring effective diagnosis and treatment. This project sought to establish concurrent validity of a new automated acoustic outcome measure, designed to be specific to adductor laryngeal dystonia (AdLD): the spectral aggregate of the high-passed fundamental frequency contour (SAHf o). Twenty speakers with AdLD read voiced phoneme-loaded (more symptomatic) and voiceless phoneme-loaded (less symptomatic) sentences. LD discontinuities (defined as phonatory breaks, frequency shifts, and creak), the acoustic ramifications of laryngeal spasms, were manually identified. The frequency content of the f o contour was examined as a function of time, and content above 1000 Hz was summed to automatically calculate SAHf o. Multiple linear regression analysis was applied to SAHf o based on LD discontinuities and sentence type (voiced or voiceless phoneme-loaded). The regression model accounted for 41.1% of the variance in SAHf o. Both the LD discontinuities and sentence type were statistically related to SAHf o. Results of this study provide evidence of concurrent validity. SAHf o is an automatic outcome measure specific to acoustic signs of AdLD that may be useful to track treatment progress.

Central Venous Pressure as End-Point Fluid Removal in Drowning Patients

Central venous pressure (CVP) is used as a guidance to control hemodynamics and to achieve the efficacy of hemodynamic balance. The drowning patient experienced a laryngeal spasm, which caused water passively enter the respiratory tract and accumulated in the lungs. Excess fluid in the lungs leads to pulmonary hypertension, venous congestion, and increased CVP. The use of diuretics guided by CVP values is the best way to achieve hemodynamic balance. Two drowning patients in different water had an increased CVP up to 12 mmHg in the sea, with serum creatinine (sCr) of 0.5 mg/dL and cumulative fluid balance (CFB) of −250 cc, and others in the lake CVP up to 14 mmHg with sCr of 0.7 mg/dL and CFB of −320 cc. Both were given furosemide at a dose of 5 mg from the first day of treatment until day 5 when both patients’ CVP returned to normal values, CVP of 5 mmHg, sCr of 0.6 mg/dL, and CFB of −1105 cc, and the others with CVP of 1 mmHg, sCr of 0.6, and CFB of −1170, then furosemide was discontinued. The use of furosemide with CVP guidance shows effective results in reducing fluids and venous congestion and is safe for the kidney, which is marked by normal values of sCr and CFB.

Spasmodic dysphonia: introductory phonetic analyses

ABSTRACT Adductor spasmodic dysphonia (ADSD) is a neurological dystonia characterised by involuntary adductor spasms of the larynx during speech. Spasm frequency is often reported to increase during syllables that begin with voiced speech sounds, especially glottal stops. Because of its underlying physical and acoustic complexities, the voicing contrast in American English (AE) appears unlikely to interact consistently with a singular physical phenomenon like laryngeal spasm. This retrospective study investigated additional phonetic contrasts and their relationship to spasm frequency. Standardised, 144-word recordings of 36 participants with adductor spasmodic dysphonia were analysed. Productions were coded for rater-perceived syllable stress, voiced/voiceless onset, vowel/consonant onset, and word-onset place and manner of production. Phonetic contexts were compared using independent sample t-tests and Kruskal-Wallis statistics. Contexts in which spasm varied significantly included stressed/unstressed syllables, content/function words, and multisyllabic/monosyllabic words. Study results reaffirm the clinical usefulness of standardised ADSD/ABSD sentences during differential diagnosis but conflict with previous studies that report a connection between ADSD spasm and phoneme voicing.

Detection of Vocal Fold Image Obstructions in High-Speed Videoendoscopy During Connected Speech in Adductor Spasmodic Dysphonia: A Convolutional Neural Networks Approach

Adductor spasmodic dysphonia (AdSD) is a neurogenic voice disorder, affecting the intrinsic laryngeal muscle control. AdSD leads to involuntary laryngeal spasms and only reveals during connected speech. Laryngeal high-speed videoendoscopy (HSV) coupled with a flexible fiberoptic endoscope provides a unique opportunity to study voice production and visualize the vocal fold vibrations in AdSD during speech. The goal of this study is to automatically detect instances during which the image of the vocal folds is optically obstructed in HSV recordings obtained during connected speech. HSV data were recorded from vocally normal adults and patients with AdSD during reading of the "Rainbow Passage", six CAPE-V sentences, and production of the vowel /i/. A convolutional neural network was developed and trained as a classifier to detect obstructed/unobstructed vocal folds in HSV frames. Manually labelled data were used for training, validating, and testing of the network. Moreover, a comprehensive robustness evaluation was conducted to compare the performance of the developed classifier and visual analysis of HSV data. The developed convolutional neural network was able to automatically detect the vocal fold obstructions in HSV data in vocally normal participants and AdSD patients. The trained network was tested successfully and showed an overall classification accuracy of 94.18% on the testing dataset. The robustness evaluation showed an average overall accuracy of 94.81% on a massive number of HSV frames demonstrating the high robustness of the introduced technique while keeping a high level of accuracy. The proposed approach can be used for efficient analysis of HSV data to study laryngeal maneuvers in patients with AdSD during connected speech. Additionally, this method will facilitate development of vocal fold vibratory measures for HSV frames with an unobstructed view of the vocal folds. Indicating parts of connected speech that provide an unobstructed view of the vocal folds can be used for developing optimal passages for precise HSV examination during connected speech and subject-specific clinical voice assessment protocols.

Efficacy of Laryngeal Mask Airway Compared to Endotracheal Tube: A Randomized Clinical Trial

BackgroundIn patients under general anesthesia, the laryngeal mask airway (LMA) is a valuable alternative to endotracheal intubation to maintain the airway. In this study, we compared the efficacy of LMA with an endotracheal tube (ETT) in plastic and reconstructive surgeries over 2 h on thorax and abdomen under general anesthesia in Hazrat Fatemeh Hospital in Tehran, Iran, in 2020.MethodsThis randomized clinical trial was performed on a sample size of 80, randomly assigned to two groups. The main variables included the ease of placement, recurrent carbon dioxide content, arterial oxygen saturation, and laryngeal and tracheal spasm. In addition, the sub-variables entailed the mean duration of anesthesia, nausea and vomiting, sore throat, and abdominal distension. The obtained data were analyzed by the SPSS software version 25.ResultsIn the present study, 76 patients were female. Mean age, recurrent carbon dioxide, arterial oxygen saturation, laryngeal and tracheal spasm, the mean duration of anesthesia, nausea and vomiting, sore throat, and abdominal distension were not significantly different between the two groups.ConclusionsThe results of this study showed that the classic laryngeal mask could be used as a means of airway control in general anesthesia for long-term surgeries of more than 2 h.

Study of Indications and Early Complications of Bronchoscopy at TUH- Lattakia During 2020 – 2021

Flexible bronchoscopy is a major diagnostic and therapeutic tool employed largely in respiratory medicine. This study was designed to determine the indications and outcome of a bronchoscopic workup at Tishreen University Hospital during the period from March 2020 to March 2021. All patients undergoing flexible bronchoscopy were subjected to full history and clinical examination, and data about patient's demographic details, indications for bronchoscopy, sedation given, specimen obtained and results of the investigation, and complications encountered were recorded. The study results revealed that of 176 bronchoscopies, 171 (97.2%) were diagnostic, and the remaining five (2.8%) were therapeutic. The mean age of patients was 54.3 ± 11.8 years, with males constituting the majority, 71.6%. Malignancy and hemoptysis were the two main indications for bronchoscopy (34.1% and 27.8%, respectively). The overall complication rate was 5.7%. The complications included bleeding in five cases, hypoxemia in three cases, laryngeal spasm in two cases, and hypertension in one case. There were no deaths related to the procedures. The overall diagnostic yield was 61.4%. Malignancy was confirmed in 70% of suspected cases; endobronchial malignancies were diagnosed in 30 patients (93.7%) out of 32 who had a macroscopically visible tumor. Tuberculosis was diagnosed in 69.2% of suspected cases, whereas bacterial pneumonia was diagnosed in 62.5%. Bronchoscopy diagnosed 81.8% of patients with lobar atelectasis. The diagnostic yield was 47% for hemoptysis. Our results confirm that flexible bronchoscopy is a valuable diagnostic tool, with a low rate of complications, particularly in patients with lung cancer. The diagnostic yield in our locality is almost similar to that reported in other series.

SUDEP in adults and children

Sudden unexpected death in epilepsy (SUDEP) represents an important cause of death in patients with epilepsy and it exceeds the expected rate of sudden death in the general population by nearly 24 times. We searched the electronic databases (Cochrane, EMBASE, Scopus, Medline, Pubmed) for studies related to etiology and risk stratification of SUDEP including data on Takotsubo cardiomyopathy (TKC) following seizures resulting in death or near death.: SUDEP is more common among males in the fourth decade of life. Risk for SUDEP is increased by early onset of seizures, low IQ, generalised tonic clonic seizures, nocturnal seizures and seizure frequency. Nonadherance to antiepileptic medications, absence of therapeutic drug level monitoring, presence of neuropathological lesions on imaging and certain subgroups like Dravet syndrome increase its risk. The risk for premature death in patients undergoing temporal lobe resection for drug resistant epilepsy decreased over time but remained above the standard population. Prolonged postictal electroencephalographic suppression was a risk factor for SUDEP in patients with generalised seizures which may indicate a cerebral electrical shutdown. Documented ictal/postictal hypoventilation, laryngeal spasm and cardiac rhythm abnormalities prior to SUDEP may suggest central apnea, neurogenic pulmonary edema, cardiac arrhythmia, or a combination of the above as a cause. Seizure triggered TKC does not seem to play a major role in the pathogenesis of SUDEP.