Congenital pyriform fossa malformations (CPFM) are rare types of branchial anomalies. The management approach was previously anatomical, based on outlining the complete surgical excision of the vestige tract. Endoscopic obliteration of the pharyngeal opening of the tract evolved as an alternative to less invasive treatment. Although different techniques have been reported, long-term follow-up data are relatively deficient. This is a retrospective analysis of patients with CPFM treated in a tertiary referral hospital. Direct laryngoscopy was the only diagnostic method used. Endoscopic radiofrequency ablation was done as described. Patients with at least 24 months of follow-up were included. Fourteen patients met inclusion criteria, 10 males and 4 females, with a mean age of 8 years. Only one patient had an external cervical component. All patients had the pharyngeal opening in the left pyriform fossa except for one. Average follow-up period was 41.5 months. No complications or recurrences were reported during the follow-up period. Endoscopic radiofrequency cauterization can be described as a safe, effective sole treatment of CPFM. The approach we adopted is simple, less demanding with long-term reliability.

Background: Osteoradionecrosis (ORN) following head and neck radiotherapy has been demonstrated to induce structural and functional alterations of the upper airway, with the potential to complicate the process of tracheal intubation. Despite its clinical relevance, there is a paucity of systematic evidence on airway characteristics in ORN and reliable predictors of difficult tracheal intubation. This study compares preoperative airway parameters and tracheal intubation outcomes in irradiated patients with and without ORN and introduces a novel preoperative ORN-Difficult-Airway Score for risk stratification. Methods: In this retrospective cohort study, airway assessments, tracheal intubation methods, and perioperative visualization parameters were evaluated in 105 patients following head and neck radiotherapy. Group differences between non-ORN and ORN were analyzed using chi-square tests. A preoperative ORN-Difficult-Airway Score was constructed using exclusively bedside parameters, based on statistically and clinically relevant predictors. Results: Patients with ORN showed significantly restricted mouth opening (p < 0.001), higher Mallampati classes, particularly Mallampati IV, and a greater need for fiberoptic tracheal intubation (p < 0.01). Direct laryngoscopy (DL) was significantly less feasible in ORN, while hyperangulated videolaryngoscopy (VL) yielded consistently positive visualization (first-pass success (FPS) 100% in both groups). Under DL, FPS was lower in ORN (54.2% vs. 79.5%), resulting in an odds ratio of 0.305. Based on observed predictors, ORN status, mouth opening <3 cm, Mallampati class, restricted neck reclination, and history of difficult intubation, a preoperative ORN-Difficult-Airway Score was developed. Conclusions: ORN has been associated with distinct alterations in airway anatomy and visualization, resulting in increased tracheal intubation complexity after head and neck radiotherapy. The proposed ORN-Difficult-Airway Score presents a clinically practical, bedside-applicable approach to stratifying the risk of tracheal intubation in this population. Prior to clinical implementation, prospective validation in larger cohorts is warranted.

HighlightsWhat are the main findings?In a simulated pediatric cardiac arrest model, the VieScope laryngoscope had better first-pass success rates and shorter intubation times than the Macintosh and Miller direct laryngoscopes, especially when chest compressions were not stopped.Performance differences between devices were minor without chest compressions but became significant during dynamic resuscitation conditions, with VieScope consistently offering better glottic visualization and procedural efficiency.What are the implications of the main findings?Optical tubular laryngoscopes may be helpful as airway management tools during pediatric cardiopulmonary resuscitation, particularly when reducing interruptions to chest compressions is important.Integrating such devices into pediatric airway training and resuscitation protocols could improve intubation performance in difficult, high-movement situations, pending validation in clinical studies.As these results were obtained in a controlled simulation setting, prospective clinical studies are needed to determine whether the observed performance differences translate into improved airway management and outcomes during real pediatric cardiopulmonary resuscitation.Background/Objectives: Effective airway management during pediatric cardiopulmonary resuscitation (CPR) is crucial but technically challenging, especially during continuous chest compressions. While direct laryngoscopy with Macintosh (MAC) or Miller (MIL) blades remains the standard, optical devices such as the VieScope (VSL) may enhance performance under dynamic resuscitation conditions. This study compared first-pass success and intubation time, as well as procedural difficulty and glottic visualization, of MAC, MIL, and VSL during simulated pediatric cardiopulmonary resuscitation. Methods: This prospective, randomized crossover simulation study involved 53 medical students. Participants performed endotracheal intubation on a high-fidelity manikin simulating a 5-year-old pediatric patient using MAC, MIL, and the Bebé VieScope laryngoscope. Each technique was evaluated in two scenarios: with and without continuous chest compressions. Results: Without chest compressions, first-pass success (FPS) and intubation time varied significantly between techniques. VSL achieved the highest FPS (100%; p = 0.032) and the shortest intubation time (27.9 ± 9.2 s; p = 0.040), performing faster than MIL and achieving higher FPS than MAC. Visualization quality, ease of intubation, and optimization maneuvers were similar across techniques. During continuous chest compressions, all outcomes differed significantly. FPS increased from MAC to MIL and VSL (p = 0.001), with MAC showing the lowest success rate. VSL showed the shortest intubation time (35.9 ± 13.0 s; p < 0.001), better glottic visualization, easier intubation, and fewer optimization maneuvers, followed by MIL. Conclusions: In this simulated pediatric cardiac arrest model, the VieScope laryngoscope demonstrated superior overall performance, especially during uninterrupted chest compressions. Optical tubular laryngoscopy may therefore provide clinically relevant benefits in pediatric resuscitation where maintaining high-quality chest compressions is crucial. Given the manikin-based design of this study, confirmation of these findings in clinical pediatric cardiac arrest settings will require further prospective clinical investigation.

Introduction: Laryngoscopy and tracheal intubation inevitably trigger a sympathoadrenal response, manifesting as tachycardia and hypertension. While video laryngoscopy (VL) offers improved glottic visualization compared to direct laryngoscopy (DL), its efficacy in specifically attenuating this hemodynamic stress remains a subject of debate. This study investigates whether VL provides superior hemodynamic stability during the critical post-intubation period by analyzing the rate pressure product (RPP) and temporal hemodynamic interactions. Methods: In this prospective, single-blind, randomized controlled trial, 40 adult patients (ASA I-II) undergoing elective surgery were allocated to either Group VL (GlideScope, n=20) or Group DL (Macintosh, n=20). Anesthesia was strictly standardized with Fentanyl 2 mcg/kg, Propofol 2 mg/kg, and Atracurium 0.5 mg/kg. Hemodynamic parameters, including systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR), were recorded at baseline (T0) and at 1 (T1), 2 (T2), and 5 (T5) minutes post-intubation. The primary analysis utilized a general linear model (Repeated Measures ANOVA) to assess Time-Group interactions, corrected for sphericity. Results: Demographics were homogeneous between groups. A significant Time-Group interaction was observed for MAP (p less than 0.001), indicating a blunted pressor response curve in the VL group. Heart Rate at 1-minute post-intubation was significantly lower in Group VL (75.45 plus or minus 11.23 bpm) compared to Group DL (90.15 plus or minus 15.22 bpm; p equals 0.001). Analysis of the rate pressure product revealed that Group DL approached ischemic thresholds, whereas Group VL maintained significantly lower myocardial workload at minutes 1 and 2 (p less than 0.01). Conclusion: Video laryngoscopy significantly attenuates the reflex tachycardia and arterial pressure surge associated with tracheal intubation compared to direct laryngoscopy. VL is recommended to minimize cardiovascular stress in susceptible surgical populations.

Videolaryngoscopy versus direct laryngoscopy for tracheal intubation by anesthesia residents in The operating room: The randomized multicenter VILARE trial protocol.

ABSTRACTVallecular cysts are uncommon birth defects that substantially restrict an infant's airway. This paper emphasizes the difficulties in diagnosing and managing a transfer case with limited resources. If these cysts are not detected early, they can have major clinical consequences. A 2‐month‐old female infant presented with progressive inspiratory stridor, respiratory distress, vomiting, and fever over one month. Initial investigations suggested pneumonia, but direct laryngoscopy revealed a large vallecular cyst compressing the laryngeal structures. Blood cultures grew Staphylococcus epidermidis (MRSE). Emergency tracheostomy preceded complete cyst excision. Postoperative tracheal cultures identified XDR Acinetobacter, managed with targeted antibiotics.

Current Trends in the Assessment and Management of Unilateral Vocal Fold Paralysis Among Practicing Speech Language Pathologists in India.

To assess the feasibility and effectiveness of administering surfactant via an orogastric feeding tube used as a thin tracheal catheter, compared with the Intubation-Surfactant-Extubation (InSurE) method, in preterm neonates with respiratory distress syndrome (RDS). This was hospital-based, randomized controlled trial. The intervention group (Group A) received surfactant via an orogastric tube with direct laryngoscopy while maintaining continuous positive airway pressure (CPAP) therapy. The control group (Group B) received surfactant using the standard InSurE technique. Data collected included demographic details, feasibility criteria, clinical condition, respiratory support requirements, complications, and final outcomes. Baseline characteristics were comparable between groups. All 120 infants in the intervention group received surfactant via the feeding tube successfully on the first attempt, with uninterrupted administration, no premedication, no conversions to intubation, no procedure-related bradycardia, desaturation, or apnea, and no significant regurgitation. The need for mechanical ventilation was significantly lower in the feeding-tube group compared with InSurE (22 vs. 35; P = .049, relative risk 0.74). The mean duration of oxygen therapy, hospital stay, rates of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) (grade II or higher), air leaks, sepsis, and mortality did not differ significantly between groups. Surfactant administration via an orogastric feeding tube inserted into the trachea is feasible, safe, and as effective as the InSurE method in preterm neonates of 28-34 weeks' gestation. This low-cost, universally available alternative has important implications for improving access to surfactant therapy in resource-limited settings of tropical low- and middle-income countries (LMICs).

Introduction: Nasotracheal Intubation (NTI) is frequently required for oral and maxillofacial surgeries, but optimal techniques for guiding the Endotracheal Tube (ETT) towards the glottis remain debated. While Magill’s forceps have traditionally been used to guide the ETT towards the glottis during NTI, the cuff inflation technique has emerged as a potentially safer alternative. Aim: To compare the intubating conditions between cuff inflation and Magill’s’s forceps techniques for NTI in adults under direct laryngoscopy. Materials and Methods: The present randomised clinical single blinded study was conducted at Dhiraj Hospital Piparia, Vadodara, Gujarat, India, from 13th July 2024 to 1st may 2025 on 80 American Society of Anaesthesiologists (ASA) I-II patients aged 18-60 years undergoing elective surgeries requiring NTI. Patients were randomly allocated into two groups using computer generated sequence: Group C (n=40) underwent NTI using the cuff inflation technique, while group M (n=40) underwent NTI using Magill’s forceps. The primary outcomes included the time required for successful intubation, number of attempts, and secondary outcomes included haemodynamic response, external laryngeal manoeuvre requirement, and complications. Data were analysed using unpaired Student’s t-test for numerical variables and Chi-square test for categorical variables. Statistical significance was set at p&lt;0.05. Results: A total of 80 patients were included in the study with 40 patients per group groups were demographically comparable. Total intubation time was significantly shorter in group C (40.38±3.95) compared to group M (51.84±4.78 seconds) (p&lt;0.001). Group C showed higher first-attempt success rate (80.0% vs 75.0%, p=0.008). External laryngeal manoeuvre was required less frequently in group C 6 (15.0%) patients compared to group M 14 (35.0%) patients (p=0.037). The cuff inflation technique demonstrated attenuated haemodynamic response with significantly lower increases in Heart Rate (HR) and blood pressure at 1 and 3 minutes post intubation. Complications including nasal bleeding and ETT cuff damage were significantly lower in group C. Conclusion: The cuff inflation technique provides superior intubating conditions compared to the Magill’s’s forceps technique, with shorter intubation time and fewer complications. It may be considered a safer and more efficient alternative for NTI under direct laryngoscopy in adults.

Universal videolaryngoscopy for double-lumen tube tracheal intubation: Subanalysis of the VIDEOLAR-SURGERY trial.

Tracheal intubation using video laryngoscopy as compared to direct laryngoscopy during cardiopulmonary resuscitation: a systematic review and meta-analysis.

We report the case of a 51‐year‐old male who experienced transient unilateral hypoglossal nerve palsy (HNP) after undergoing elective shoulder surgery under general anesthesia. Tracheal intubation was performed using a C‐MAC D‐Blade video laryngoscope (Karl Storz). Intubation was uneventful, with clear visualization of the vocal cords corresponding to a Cormack–Lehane Grade I view, no airway trauma was visible. Shortly after extubation, the patient complained of tongue swelling, dysarthria, and dysphagia. Clinical examination confirmed an isolated ipsilateral HNP. A brain and neck MRI conducted 4 h postoperatively showed no structural abnormalities along the hypoglossal nerve pathway, and an otolaryngological assessment identified no additional lesions. The patient was managed conservatively, including supportive speech therapy, and made a complete recovery within 14 weeks. This case report highlights a rare incidence of isolated HNP, which occurred in a patient with prior cervical spine fusion and obesity during video laryngoscopy. Possible contributing factors include compression or stretching of the hypoglossal nerve due to airway manipulation, patient positioning, or instrumentation in proximity of cicatrized cervical soft tissue. It is the first case report of HNP following video laryngoscopy with complete recording of the video laryngoscopy. Although video laryngoscopy enhances visual access during intubation, clinicians should remain cautious about potential localized tissue and nerve stress, particularly when using hyperangulated blades. This case highlights that video laryngoscopy does not inherently guarantee reduced soft tissue trauma when compared with traditional direct laryngoscopy.

Objectives: Tracheal intubation is a critical airway management skill frequently performed by resident physicians, yet the literature comparing video laryngoscopy and direct laryngoscopy in this trainee population remains limited. Previous studies highlight differences in success rates, complications, and visualization quality between both techniques, but their applicability to real-world resident training requires further exploration. We aimed to compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy for tracheal intubation performed by residents at a tertiary care cardiac hospital in Karachi. Methodology: This non-randomized comparative observational study enrolled 166 adult patients undergoing tracheal intubation from September 2023 to February 2024. Participants were assigned to either video laryngoscopy (Group-V) or direct laryngoscopy (Group-D) based on consecutive sampling. Efficacy was defined as first-attempt success, and safety was assessed by the absence of complications such as desaturation, aspiration, soft-tissue injury, bronchospasm, or esophageal intubation. Results: Each group comprised 83 patients. Group-V demonstrated a significantly higher first-attempt success rate (78.3%) than Group-D (59.0%) (p = 0.007) and required fewer attempts (1.24 ± 0.46 vs. 1.42 ± 0.52; p &lt; 0.001). Complication-free intubation was also more frequent in Group-V (68.7%) compared to Group-D (53.0%) (p = 0.039). Conclusion: Video laryngoscopy was associated with superior efficacy and a more favorable safety profile compared with direct laryngoscopy in resident-performed intubations. These findings support the integration of video laryngoscopes into residency training programs to enhance airway management skills and reduce adverse events.

This case report described the entire process of a 72-year-old Chinese woman undergoing resection of a giant thyroid tumor. The novelty of this case report lies in its emphasis on the crucial role of anesthetic management for giant thyroid tumors, particularly in patients with concurrent cardiac comorbidities. We present a 72-year-old Chinese female with a giant thyroid tumor caused respiratory compromise due to tracheal compression, complicated by atrial septal defect. She required general anesthesia for tumor resection. A multidisciplinary team developed critical contingency strategies: (1) awake endotracheal intubation under direct laryngoscopy, (2) a remimazolam/sufentanil combination for procedural tolerance, (3) improved tracheal catheter preparation, and (4) surgical tracheostomy readiness. Anesthesia maintenance was achieved with sevoflurane, supplemented by sufentanil and remifentanil for multimodal analgesia and vecuronium/mivacurium neuromuscular blockade. Successful tumor resection achieved complete decompression, with no postoperative complications documented during 30-day follow-up. This case demonstrates that meticulous interdisciplinary communication and structured perioperative protocols form the cornerstone of safe anesthesia practice for patients with dual pathology of airway compromise and cardiac comorbidities, providing crucial insights for managing such complex clinical scenarios.

Laryngeal lymphoid hyperplasia is an extremely rare pathology, and clinical cases of this pathology described in the literature are limited. This article presents a clinical case of a patient with nodular idiopathic reactive lymphoid hyperplasia of the vestibular larynx. Patient G., 53 years old, was admitted to the department in April 2024 complaining of tracheostomy, difficulty swallowing, hoarseness. After the examination, the diagnosis was established: neoplasm of the larynx. Laryngeal stenosis. Tracheostomy. A neoplasm removal was performed via direct laryngoscopy under general anesthesia using radiofrequency device Surgitron and an ARC TrueBlue 445 nm surgical laser. The morphological picture was similar to a lymphoproliferative disorder. However, immunohistochemical reactions with antibodies to bcl-6 (clone GI191E/A8, Cell Marque Corporation) and to bcl-2 (clone 124, Cell Marque Corporation) canceled the diagnosis of lymphoma and established the diagnosis of supraglottic submucosa nodular idiopathic reactive lymphoid hyperplasia. The patient was decannulated and fully rehabilitated. Idiopathic lymphoid hyperplasia of the larynx is an extremely rare cause of airway stenosis that requires surgical intervention. The diagnosis should be differentiated with lymphoproliferative disorders and with foci of ectopic tonsil tissue. The diagnosis should be based on a thoroughly conducted histological examination with immunohistochemical reactions.

We aimed to compare the 72-hour survival of the endotracheal intubation (ETI) with video laryngoscope (VL), ETI with direct laryngoscope (DL), and supraglottic airway (SGA) in out-of-hospital cardiac arrest (OHCA) patients in Korea. This study included adult OHCA patients who received advanced airway management by designated response teams for severe disease, using a nationwide OHCA registry in South Korea from July 2019 to December 2021. The primary outcome was 72-hour survival, and secondary outcomes were survival to hospital discharge and good neurological recovery. Multivariable logistic regression was used, adjusted for confounders, to compare the outcomes among the three airway management methods. Among 77,629 OHCA cases, 10,857 were included. SGA was attempted in 9,379 cases, ETI with DL in 493 cases, and ETI with VL in 985 cases. The rates of any prehospital ROSC and 72-hour survival were 13.3% and 11.0% for SGA, 16.0% and 11.4% for ETI with DL, and 18.2% and 11.9% for ETI with VL. Compared to SGA, ETI with VL was significantly associated with 72-hour survival: adjusted odds ratio (OR) [95% confidence interval (CI)] 1.34 (1.06-1.70) for ETI with VL and 1.13 (0.81-1.56) for ETI with DL). There was no significant association between the type of AAM and survival to discharge or good neurological recovery. In an emergency medical service system staffed by advanced emergency medical technician-level providers, ETI with VL might be associated with improved 72-hour survival compared to SGA. However, this short-term benefit did not extend to survival to hospital discharge.

Only 43 patients with laryngeal melanosis have been reported to date. Concomitant malignancy and dysplasia of the upper aerodigestive tract, ranging from 26% to 50%, have been encountered with this condition. Given the above, we undertook this study to assess the burden of laryngeal melanosis diagnosed in a tertiary care center. This was a retrospective observational study done with a review of all patients with laryngeal biopsies received over the previous 5-year period (2017-2022), on encountering an index patient. A representative slide from each patient was stained with Masson Fontana and bleached with potassium permanganate, and immunohistochemistry was performed using S100 and HMB45 (PMEL), wherever feasible. Sixty-five patients with laryngeal biopsies reported were included in the study, and laryngeal melanosis was detected in 9 patients (14% prevalence) of the total laryngeal biopsies. Seven out of 9 patients were associated with neoplasm, 6 patients (67%) with concomitant squamous cell carcinoma, and 1 (11%) with moderate dysplasia. We add another 9 patients to the list of laryngeal melanosis, based on our extensive literature search, taking the total to 52. We observed instances where laryngeal melanosis co-occurred with malignancies of the upper aerodigestive tract. Identifying laryngeal melanosis during direct laryngoscopy can serve as a marker that encourages surgeons and pathologists to exercise prudence and ensure thorough investigation.

IntroductionFirst-pass success (FPS) in emergency tracheal intubation is a key quality metric linked to fewer intubation-related complications, but data from low-income settings are limited. This study aimed to measure FPS and identify intubation-related complications in two tertiary hospitals in Addis Ababa, Ethiopia.MethodsWe conducted a prospective, cross-sectional observational study of consecutive emergency and ICU tracheal intubations at Tikur Anbessa Specialized Hospital (TASH) and Zewditu Memorial Hospital (ZMH) from May to October 2024. Patients aged 13 years or older undergoing emergency intubations were included. Online tool was developed to collect key variables from clinicians. The primary outcome was FPS (successful endotracheal tube placement on the first laryngoscope insertion). Bivariate analyses and multivariable logistic regression were used to identify independent predictors; adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported.ResultsA total of 112 intubations were analyzed. Median age of patients was 37.5 years (IQR 25–55); 62.5% were male. Hypoxic respiratory failure was the predominant indication (68.8%). Direct laryngoscopy was used in all cases; the most common induction strategy was ketamine (50/112 [44.6%]) with succinylcholine (67/112 [59.8%]) as the neuromuscular blocking agent. FPS was 64.3% (72/112). Additional successes occurred on the second (25.0%), third (8.0%), and ≥ 4 attempts (2.7%). One or more complications occurred in 42 out of the 112 cases (37.5%; 95% CI 28.5–46.5%), highlighting a substantial immediate adverse-event burden; cardiovascular instability occurred in 22.3%, cardiac arrest in 5.4%, and death within one hour in 2.7%. On adjusted analysis, operator training level and airway visualization were the strongest predictors: Year-II residents (aOR 46.81; 95% CI 3.03–722.72; p = 0.006) and Year-III residents (aOR 406.30; 95% CI 13.72–12,033.01; p < 0.001) had markedly higher odds of FPS compared to Year-I residents. Intubations without anticipated difficulty were more likely to succeed (aOR 10.74; 95% CI 1.01–114.45; p = 0.049). A Cormack–Lehane grade III view predicted failure (aOR 0.005; 95% CI 0.000–0.828; p = 0.042), while an abducted vocal cord favored success (aOR 23.96; 95% CI 2.93–195.76; p = 0.003).ConclusionFPS in these Addis Ababa hospitals (Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital) was 64.3%, a level we consider suboptimal compared with commonly cited benchmarks of ≥ 80%. This is lower than pooled benchmarks reported from large high-income country series (~ 79–84%) but within the range reported in some low- and middle-income settings. Operator experience and airway visualization were the dominant determinants of one-pass success. Given the high immediate complication rate (37.5%), targeted supervised training, anticipation of difficult anatomy, and prioritized expansion of airway adjuncts (e.g., bougie, phased introduction of video laryngoscopy and capnography) should be implemented to improve FPS and reduce harm in resource-limited emergency settings.

The current anesthetic standard for laryngoscopy in rats utilizes injectable intraperitoneal anesthesia. Injectable anesthesia is suboptimal for short procedures due to variability in anesthesia duration and anesthetic side effects. Conversely, inhalational gas anesthesia offers precise titration with a rapid onset and offset. However, its use during laryngoscopy has not been documented due to existing administration techniques obstructing direct visualization of the larynx. The technique described here allows real-time visualization of the rat larynx with concurrent administration of inhaled anesthetic gas. This method is particularly well-suited for recurrent laryngeal nerve or vocal fold pathology studies, where repeat visualization of the larynx is necessary.

Airway Management Practices and Outcomes Over Time in Neonates and Young Infants Presenting for Cardiac Procedures.