• J Clin Anesth · Mar 1996

    Comparative Study Clinical Trial

    Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation.

    • J L Benumof and S D Cooper.
    • Department of Anesthesiology University of California, San Diego Medical Center 92103-8812, USA.
    • J Clin Anesth. 1996 Mar 1;8(2):136-40.

    Study ObjectiveTo determine the improvement in laryngoscopic view obtained using both the Macintosh and Miller blades by applying optimal external laryngeal manipulation (OELM).DesignProspective, with each patient serving as his or her own control.SettingInpatient operating rooms of a University Medical Center.Patients181 informed and consenting adult nonpregnant patients requiring general anesthesia and tracheal intubation. The only exclusion criteria was the need to apply cricoid pressure to prevent aspiration of gastric contents.InterventionsAnesthetized, paralyzed patients underwent laryngoscopy without external laryngeal manipulation and the laryngoscopic view was graded ("A") according to visualized structures [1.0-1.9 = all (1.0) or part of the vocal cords (90% = 1.1 and 10% = 1.9); 2 = just the arytenoids; 3 = just the epiglottis; 4 = just the soft palate]. The larynx was then quickly manipulated by the thumb and index and middle fingers of the laryngoscopist's right hand in both cephalad and posterior directions over the hyoid, thyroid, and cricoid cartilages until it was determined which vector and spot produced the optimal laryngoscopic view ("B").Measurements And Main ResultsIt was found that in every patient with a "A" greater than 1.0, OELM improved the view; i.e., "B" decreased relative to "A." For both the Macintosh blade patients and Miller blade patients with an "A" equal to 2, "B" decreased by one whole laryngoscopic grade in all patients. For both the Macintosh and Miller blade patients with an "A" equal to 3, "B" decreased by at least one whole laryngoscopic grade in all patients and by two laryngoscopic grades in most patients. No patient had an "A" equal to 4. The distribution of optimal-external-laryngeal-manipulation (OELM) spots for all patients was 1%, 40%, 48%, and 11% for the hyoid, high thyroid, low thyroid, and cricoid cartilages, respectively, and the distribution was not significantly different for either the Macintosh and Miller blade groups or for the "A" and "B" subgroups (i.e., "A" < 1.9, = 2 or = 3).ConclusionsWe conclude that OELM can improve the laryngoscopic view by at least one whole grade, that the best way to determine OELM for an individual patient is on an empirical basis by manipulation of the larynx with the laryngoscopist's right hand, and that OELM should be an instinctive and reflex response to any "A" of 2, 3, or 4.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.