The Comparison Between Inhalation and Total Intravenous Anesthesia Effect on Voice With Supraglottic Airway Devices for Short-term Anesthesia.

OBJECTIVE: Supraglottic airway devices (SADs) are a good alternative to endotracheal intubation (ETI) in short-term anesthesia applications since they have advantages including easy application, lower cost, enabling spontaneous ventilation. Total intravenous anesthesia (TIVA) and desflurane anesthesia allowing rapid recovery are anesthesia methods to be selected. Inhalation anesthesia by desflurane may cause adverse effects on airway mucosa and vocal cord functions. The aim of the present study was to compare the effect of the chosen anesthesia method on voice in gynecological patients who underwent short-term anesthesia with SADs. MATERIAL AND METHOD: Seventy four patients whom short-term surgical procedure was planned in the Gynecology and Obstetrics Clinic were randomized into two groups for desflurane anesthesia (group D) and TIVA (group T). Voice recording was performed through larynx examination before anesthesia. Perioperative hemodynamic parameters, airway complications and postoperative airway complications were recorded. Laryngeal examination and voice recording were performed for the second time after 24 hours following the anesthesia procedure. Acoustic voice analysis of the patients was evaluated through the Praat program. The conditions including sore throat, dysphagia, and hoarseness were investigated after the anesthesia. Acoustic and aerodynamic properties of the voice, airway complications and pharyngolaryngeal complaints related to the use of SADs were compared in the patients. RESULT: There was not any significant difference between the groups for demographic data. The SADs type and size have similar characteristics. No significant difference was detected between Group T and Group D for anesthesia duration (P = 0.964). Both anesthesia methods cause similar effects on pharyngolaryngeal functions and voice. No significant difference was found between Group T and Group D in parameters other than the shimmer value of acoustic analysis. A statistically significant increase was observed in the Shimmer variable of group D (P < 0.05). When group T and group D were compared, there was not any significant difference in terms of airway complications, sore throat, dysphagia, and hoarseness. CONCLUSION: The TIVA and desflurane anesthesia presented similar clinical effects on voice and pharyngolaryngeal morbidity in the short-term gynecological operations through SADs. The increased shimmer value of acoustic voice analysis in Group D suggests that desflurane anesthesia may cause clinically insignificant deterioration on the voice. Further comprehensive studies are needed in order to demonstrate the effect of anesthetic agents on larynx functions in patients whom SADs is used.

Original Research: Aerosolized Lidocaine: Effective for Safer Arousal After Suspension Laryngoscopy.

AIM: To examine the systemic and local effects of the lidocaine on the larynx and trachea which is applied after the end of the surgery and through various application methods. STUDY DESIGN: Randomized controlled prospective study. METHOD: The study is composed of patients who underwent suspension laryngoscopy (SL) for benign laryngeal diseases (cysts, polyp, granuloma, etc) and American Society of Anesthesiologists (ASA) I, between January 2017 and January 2018. The patients were randomly divided into 3 groups. In the first group nothing is applied at the end of the surgery and called as control group, second group received 7 pufs of aerosolized 10% lidocaine solution (70 mg) over larynx and trachea and third group received cotton swaps that impregnated in 1 ml of 20 mg lidocaine solution over surgical area for 1 minutes. Operation and arousal times, heart rate and mean arterial blood pressure levels were noted and compared. Also laryngospasm, cough, and agitation scores were obtained during arousal. RESULTS: 64 patients were included in the study. Laryngospasm was not observed in any of the patients. In group 2 (aerosolized lidocaine group), patients' blood pressure remained similar while increased in other groups (P < 0.05). Agitation scores were significantly lower in group 2 compared to the other groups (P = 0.012). Cough reflex is observed less in group 2 but result was not statistically significant (P = 0.13) CONCLUSION: The usage of aerosolized lidocaine after suspension laryngoscopy is very effective in blocking the stimulation of superior laryngeal nerve and sympathetic nerves which were responsible for the pressor reflexes. The inhibition of these reflexes before or during arousal could secure a safer arousal.

Risk Factors and Diagnostic Methods in Vocal Cord Mucosal Lesions.

OBJECTIVES: This study was an examination of malignancy risk determined according to clinical characteristics and preoperative diagnosis in vocal cord lesions compared with the definitive pathology results. METHODS: This was a retrospective study of the files of patients who were admitted to a clinic due to hoarseness and/or a laryngeal lesion and underwent a suspension laryngoscopy (SL) between 2014 and 2018. The patient files were examined and the parameters of age, gender, smoking status, alcohol use, and the site of the lesion were compared for the risk of malignancy. The details of the preoperative diagnoses, peroperative findings, and definite pathology results were evaluated for agreement. RESULTS: In all, 296 cases were reviewed. Since some patients had undergone multiple SL procedures, only the final pathology results of these patients were included in the study and the final total was 260 patients. The study population consisted of 191 (73.5%) male and 69 (26.5%) female patients. Of the group, 169 (65%) were smokers and 13 (5%) consumed alcohol. The lesions were left-sided in 106 (40.8%), right-sided in 120 (46.2%), and bilateral in 34 (13.1%) cases. A total of 68 (26.2%) cases were malignant, 165 (63.5%) were benign, and 27 (10.4%) were determined to be premalignant. Analysis of patient age revealed that the risk of malignancy was significantly higher in patients in the fifth or sixth decade of life (p<0.001). Examination of gender and the risk of malignancy indicated that 64 (94.1%) of the malignant patients were male and 4 (5.9%) were female (p<0.001). It was also found that 64 of the malignant patients (94.1%) were smokers (p<0.001). Only 8 (11.8%) of the patients with malignant lesions used alcohol, and no significant relationship was found (p=0.018). The association of malignancy with the lesion site was similar (p=0.89). Logistic regression analysis determined that male gender increased the risk of malignancy 6.45% and smoking increased the risk 7.81%. CONCLUSION: Microscopic examination of the lesion and palpation are very important in the diagnosis of patients with hoarseness and laryngeal lesion. Smoking, advanced age, and male gender increased the risk of malignancy of vocal cord lesions.