Evaluation of the impact of deep neuromuscular blockade on surgical conditions for laryngeal microsurgery with High Frequency Jet Ventilation. A comparison with no block during intravenous general anesthesia with topical lidocaine
Laryngeal transoral surgery classically requires a neuromuscular block (NMB) to facilitate tracheal intubation and to improve surgical conditions. However, the short duration of most procedures and the potential complications of residual NMB lead to consider a no block approach. The hypothesis that...
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| Veröffentlicht in: | American journal of otolaryngology 2022-01, Vol.43 (1), p.103187-103187, Article 103187 |
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| creator | Putz, Laurie Lovqvist, Linda Bachy, Vincent Van der Vorst, Sébastien Jamart, Jacques Dubois, Philippe E. |
| description | Laryngeal transoral surgery classically requires a neuromuscular block (NMB) to facilitate tracheal intubation and to improve surgical conditions. However, the short duration of most procedures and the potential complications of residual NMB lead to consider a no block approach. The hypothesis that intravenous anesthesia (remifentanil and propofol infusions) without NMB but including glottis topical lidocaine anesthesia would allow clinically acceptable laryngeal exposure and good surgical conditions was tested in the specific context of procedures undergone with High Frequency Jet Ventilation (HFJV).
A prospective randomized clinical comparison.
66 consenting patients were planned to receive 0.6 mg·kg−1 rocuronium or saline at random. The outcome measurements included the time and conditions to complete suspended laryngoscopy, and the surgical conditions rated by the surgeon. Any vocal cord movement or coughing was recorded. Data were compared using a Wilcoxon rank-sum test for numerical variables and chi-square test for categorical ones. Treatment failure was defined as an impossible laryngoscopy or a grade 4 surgical field occurring at any time during surgery and was compared to its null theoretical value by a general z-test. An interim analysis after completion of 50% patients was performed using Pocock boundaries at 0.0294 significance levels.
A significant failure rate occurred in the non paralysed group (27%, p |
| doi_str_mv | 10.1016/j.amjoto.2021.103187 |
| format | Article |
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A prospective randomized clinical comparison.
66 consenting patients were planned to receive 0.6 mg·kg−1 rocuronium or saline at random. The outcome measurements included the time and conditions to complete suspended laryngoscopy, and the surgical conditions rated by the surgeon. Any vocal cord movement or coughing was recorded. Data were compared using a Wilcoxon rank-sum test for numerical variables and chi-square test for categorical ones. Treatment failure was defined as an impossible laryngoscopy or a grade 4 surgical field occurring at any time during surgery and was compared to its null theoretical value by a general z-test. An interim analysis after completion of 50% patients was performed using Pocock boundaries at 0.0294 significance levels.
A significant failure rate occurred in the non paralysed group (27%, p < 0.001). No coughing and no vocal cords movement occurred in the NMB group. Poorer surgical conditions were obtained without NMB (p = 0.011).
Inducing a deep NMB ensured improved conditions during direct laryngeal microsurgery with HFJV.</description><identifier>ISSN: 0196-0709</identifier><identifier>EISSN: 1532-818X</identifier><identifier>DOI: 10.1016/j.amjoto.2021.103187</identifier><identifier>PMID: 34536915</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Anesthesia ; Anesthesia, General - methods ; Anesthesia, Intravenous - methods ; Catheters ; Chi-square test ; Complications ; Deep neuromuscular block ; Electrocardiography ; Failure rates ; Female ; General anesthesia ; Glottis ; High frequencies ; High Frequency Jet Ventilation ; High-Frequency Jet Ventilation - methods ; Humans ; Intravenous administration ; Intubation ; Intubation, Intratracheal ; Laryngeal microsurgery ; Laryngoscopy ; Laryngoscopy - methods ; Larynx ; Larynx - surgery ; Lasers ; Lidocaine ; Local anesthesia ; Male ; Medical instruments ; Microsurgery ; Microsurgery - methods ; Middle Aged ; Neuromuscular Blockade - methods ; Patients ; Propofol ; Prospective Studies ; Remifentanil ; Rocuronium ; Statistical tests ; Surgery ; Surgical conditions ; Treatment Outcome ; Ventilation ; Vocal cords ; Vocal organs ; Young Adult</subject><ispartof>American journal of otolaryngology, 2022-01, Vol.43 (1), p.103187-103187, Article 103187</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Jan 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-76fce8b3fd4918c8f7b4d500c61ec8d97beeb9821546eee0800b77bdd42d97583</citedby><cites>FETCH-LOGICAL-c390t-76fce8b3fd4918c8f7b4d500c61ec8d97beeb9821546eee0800b77bdd42d97583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S019607092100288X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34536915$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Putz, Laurie</creatorcontrib><creatorcontrib>Lovqvist, Linda</creatorcontrib><creatorcontrib>Bachy, Vincent</creatorcontrib><creatorcontrib>Van der Vorst, Sébastien</creatorcontrib><creatorcontrib>Jamart, Jacques</creatorcontrib><creatorcontrib>Dubois, Philippe E.</creatorcontrib><title>Evaluation of the impact of deep neuromuscular blockade on surgical conditions for laryngeal microsurgery with High Frequency Jet Ventilation. A comparison with no block during intravenous general anesthesia with topical lidocaine</title><title>American journal of otolaryngology</title><addtitle>Am J Otolaryngol</addtitle><description>Laryngeal transoral surgery classically requires a neuromuscular block (NMB) to facilitate tracheal intubation and to improve surgical conditions. However, the short duration of most procedures and the potential complications of residual NMB lead to consider a no block approach. The hypothesis that intravenous anesthesia (remifentanil and propofol infusions) without NMB but including glottis topical lidocaine anesthesia would allow clinically acceptable laryngeal exposure and good surgical conditions was tested in the specific context of procedures undergone with High Frequency Jet Ventilation (HFJV).
A prospective randomized clinical comparison.
66 consenting patients were planned to receive 0.6 mg·kg−1 rocuronium or saline at random. The outcome measurements included the time and conditions to complete suspended laryngoscopy, and the surgical conditions rated by the surgeon. Any vocal cord movement or coughing was recorded. Data were compared using a Wilcoxon rank-sum test for numerical variables and chi-square test for categorical ones. Treatment failure was defined as an impossible laryngoscopy or a grade 4 surgical field occurring at any time during surgery and was compared to its null theoretical value by a general z-test. An interim analysis after completion of 50% patients was performed using Pocock boundaries at 0.0294 significance levels.
A significant failure rate occurred in the non paralysed group (27%, p < 0.001). No coughing and no vocal cords movement occurred in the NMB group. Poorer surgical conditions were obtained without NMB (p = 0.011).
Inducing a deep NMB ensured improved conditions during direct laryngeal microsurgery with HFJV.</description><subject>Adult</subject><subject>Anesthesia</subject><subject>Anesthesia, General - methods</subject><subject>Anesthesia, Intravenous - methods</subject><subject>Catheters</subject><subject>Chi-square test</subject><subject>Complications</subject><subject>Deep neuromuscular block</subject><subject>Electrocardiography</subject><subject>Failure rates</subject><subject>Female</subject><subject>General anesthesia</subject><subject>Glottis</subject><subject>High frequencies</subject><subject>High Frequency Jet Ventilation</subject><subject>High-Frequency Jet Ventilation - methods</subject><subject>Humans</subject><subject>Intravenous administration</subject><subject>Intubation</subject><subject>Intubation, Intratracheal</subject><subject>Laryngeal microsurgery</subject><subject>Laryngoscopy</subject><subject>Laryngoscopy - methods</subject><subject>Larynx</subject><subject>Larynx - surgery</subject><subject>Lasers</subject><subject>Lidocaine</subject><subject>Local anesthesia</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Microsurgery</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Neuromuscular Blockade - methods</subject><subject>Patients</subject><subject>Propofol</subject><subject>Prospective Studies</subject><subject>Remifentanil</subject><subject>Rocuronium</subject><subject>Statistical tests</subject><subject>Surgery</subject><subject>Surgical conditions</subject><subject>Treatment Outcome</subject><subject>Ventilation</subject><subject>Vocal cords</subject><subject>Vocal organs</subject><subject>Young Adult</subject><issn>0196-0709</issn><issn>1532-818X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks9u1DAQxiMEokvhDRCyxIVLFjt_nQtSVbUUVIkLIG6WY0-yDokdbGfRvjDPwWRTOHDgZNnzm_k-z0ySvGR0zyir3g57OQ0uun1GM4ZPOeP1o2THyjxLOePfHic7ypoqpTVtLpJnIQyU0rzIy6fJRV6UedWwcpf8ujnKcZHROEtcR-IBiJlmqeJ60wAzsbB4Ny1BLaP0pB2d-i41EOTD4nuj5EiUs9qsJQLpnCfInWwPGJiM8m7FwJ_ITxMP5M70B3Lr4ccCVp3IR4jkK9hoxrOFPbnCYqjvTUCBc4Z1myjRize2J8ZGL49g3RJIDxY86kgLAa0HI7ec6OazsdFop6Sx8Dx50skxwIuH8zL5cnvz-fouvf_0_sP11X2q8obGtK46BbzNO100jCve1W2hS0pVxUBx3dQtQNvwjJVFBQCUU9rWdat1kWGw5Pll8marO3uHXwxRTCYoGEd0iIZFVtZFzjktKkRf_4MObvEW3YmsomWGAzpTxUatjQweOjF7M2GDBaNi3QMxiG0PxLoHYtsDTHv1UHxpJ9B_k_4MHoF3GwDYjaMBL4IyOBLQxoOKQjvzf4Xf2nHM0g</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Putz, Laurie</creator><creator>Lovqvist, Linda</creator><creator>Bachy, Vincent</creator><creator>Van der Vorst, Sébastien</creator><creator>Jamart, Jacques</creator><creator>Dubois, Philippe E.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7QR</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>202201</creationdate><title>Evaluation of the impact of deep neuromuscular blockade on surgical conditions for laryngeal microsurgery with High Frequency Jet Ventilation. A comparison with no block during intravenous general anesthesia with topical lidocaine</title><author>Putz, Laurie ; Lovqvist, Linda ; Bachy, Vincent ; Van der Vorst, Sébastien ; Jamart, Jacques ; Dubois, Philippe E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-76fce8b3fd4918c8f7b4d500c61ec8d97beeb9821546eee0800b77bdd42d97583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Anesthesia</topic><topic>Anesthesia, General - methods</topic><topic>Anesthesia, Intravenous - methods</topic><topic>Catheters</topic><topic>Chi-square test</topic><topic>Complications</topic><topic>Deep neuromuscular block</topic><topic>Electrocardiography</topic><topic>Failure rates</topic><topic>Female</topic><topic>General anesthesia</topic><topic>Glottis</topic><topic>High frequencies</topic><topic>High Frequency Jet Ventilation</topic><topic>High-Frequency Jet Ventilation - methods</topic><topic>Humans</topic><topic>Intravenous administration</topic><topic>Intubation</topic><topic>Intubation, Intratracheal</topic><topic>Laryngeal microsurgery</topic><topic>Laryngoscopy</topic><topic>Laryngoscopy - methods</topic><topic>Larynx</topic><topic>Larynx - surgery</topic><topic>Lasers</topic><topic>Lidocaine</topic><topic>Local anesthesia</topic><topic>Male</topic><topic>Medical instruments</topic><topic>Microsurgery</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Neuromuscular Blockade - methods</topic><topic>Patients</topic><topic>Propofol</topic><topic>Prospective Studies</topic><topic>Remifentanil</topic><topic>Rocuronium</topic><topic>Statistical tests</topic><topic>Surgery</topic><topic>Surgical conditions</topic><topic>Treatment Outcome</topic><topic>Ventilation</topic><topic>Vocal cords</topic><topic>Vocal organs</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Putz, Laurie</creatorcontrib><creatorcontrib>Lovqvist, Linda</creatorcontrib><creatorcontrib>Bachy, Vincent</creatorcontrib><creatorcontrib>Van der Vorst, Sébastien</creatorcontrib><creatorcontrib>Jamart, Jacques</creatorcontrib><creatorcontrib>Dubois, Philippe E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of otolaryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Putz, Laurie</au><au>Lovqvist, Linda</au><au>Bachy, Vincent</au><au>Van der Vorst, Sébastien</au><au>Jamart, Jacques</au><au>Dubois, Philippe E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of the impact of deep neuromuscular blockade on surgical conditions for laryngeal microsurgery with High Frequency Jet Ventilation. A comparison with no block during intravenous general anesthesia with topical lidocaine</atitle><jtitle>American journal of otolaryngology</jtitle><addtitle>Am J Otolaryngol</addtitle><date>2022-01</date><risdate>2022</risdate><volume>43</volume><issue>1</issue><spage>103187</spage><epage>103187</epage><pages>103187-103187</pages><artnum>103187</artnum><issn>0196-0709</issn><eissn>1532-818X</eissn><abstract>Laryngeal transoral surgery classically requires a neuromuscular block (NMB) to facilitate tracheal intubation and to improve surgical conditions. However, the short duration of most procedures and the potential complications of residual NMB lead to consider a no block approach. The hypothesis that intravenous anesthesia (remifentanil and propofol infusions) without NMB but including glottis topical lidocaine anesthesia would allow clinically acceptable laryngeal exposure and good surgical conditions was tested in the specific context of procedures undergone with High Frequency Jet Ventilation (HFJV).
A prospective randomized clinical comparison.
66 consenting patients were planned to receive 0.6 mg·kg−1 rocuronium or saline at random. The outcome measurements included the time and conditions to complete suspended laryngoscopy, and the surgical conditions rated by the surgeon. Any vocal cord movement or coughing was recorded. Data were compared using a Wilcoxon rank-sum test for numerical variables and chi-square test for categorical ones. Treatment failure was defined as an impossible laryngoscopy or a grade 4 surgical field occurring at any time during surgery and was compared to its null theoretical value by a general z-test. An interim analysis after completion of 50% patients was performed using Pocock boundaries at 0.0294 significance levels.
A significant failure rate occurred in the non paralysed group (27%, p < 0.001). No coughing and no vocal cords movement occurred in the NMB group. Poorer surgical conditions were obtained without NMB (p = 0.011).
Inducing a deep NMB ensured improved conditions during direct laryngeal microsurgery with HFJV.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34536915</pmid><doi>10.1016/j.amjoto.2021.103187</doi><tpages>1</tpages></addata></record> |
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| subjects | Adult Anesthesia Anesthesia, General - methods Anesthesia, Intravenous - methods Catheters Chi-square test Complications Deep neuromuscular block Electrocardiography Failure rates Female General anesthesia Glottis High frequencies High Frequency Jet Ventilation High-Frequency Jet Ventilation - methods Humans Intravenous administration Intubation Intubation, Intratracheal Laryngeal microsurgery Laryngoscopy Laryngoscopy - methods Larynx Larynx - surgery Lasers Lidocaine Local anesthesia Male Medical instruments Microsurgery Microsurgery - methods Middle Aged Neuromuscular Blockade - methods Patients Propofol Prospective Studies Remifentanil Rocuronium Statistical tests Surgery Surgical conditions Treatment Outcome Ventilation Vocal cords Vocal organs Young Adult |
| title | Evaluation of the impact of deep neuromuscular blockade on surgical conditions for laryngeal microsurgery with High Frequency Jet Ventilation. A comparison with no block during intravenous general anesthesia with topical lidocaine |
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