Laparoscopic approaches to the retropubic space: three alternatives with anatomical considerations.

INTRODUCTION: Many urogynecological and surgical laparoscopic interventions require access to the retropubic space, also known as the space of Retzius. Especially in patients with a history of previous surgery in this area or in general in the lower abdomen, the preparation may be complicated by adhesions and scar tissue. The necessity to combine several laparoscopic procedures in one surgical session may require consideration of the most appropriate way to approach the retropubic space. MATERIAL AND METHODS: We describe and discuss three different options to access the space of Retzius via laparoscopy: the medial transperitoneal, the extraperitoneal and the lateral transperitoneal approach. For all approaches, we used one umbilical trocar and two trocars in the lower abdomen. RESULTS: An algorithm was developed to select the most appropriate access route to the retropubic space, depending on the history of previous surgeries and accompanying interventions. CONCLUSION: The knowledge of different access routes to the retropubic space offers the possibility of adjusting the surgical procedure to the individual constellation of the patient.

Preclinical safety testing for morcellation and extraction for an endobag with sealable ports: in vitro pilot study.

BACKGROUND: Electromechanical power morcellation is an important tool of modern laparoscopy. Recent reports on the spread of previously undetected malignancy by power morcellation indicate the need for additional protective devices to reduce this risk. We conducted a study to obtain the first data concerning the safety of an endobag with three closable ports during morcellation and subsequent bag extraction under in vitro conditions, mimicking the settings in our operating theater. The second purpose of the study was to establish a minimal width of the skin incision necessary to safely extract the sealed bag after morcellation. METHODS: The morcellation test was carried out on 11 stained porcine muscle tissue samples with one additional sample as a control. The insufflation pressure was set at 12 mmHg. After filling the endobag with blue dye solution, an additional extraction test was conducted by pulling the closed bag through a template with apertures of various diameters. For each opening, a series of ten bag extractions was carried out. RESULTS: No loss of solid material or fluid was recorded during the morcellation test. The extraction test showed a loss of fluid for template openings smaller than 18 mm. The force necessary to extract the bag was inversely related to the width of the aperture. CONCLUSIONS: The data suggest that under the evaluated conditions, the use of a closable morcellation bag can considerably improve the patient's safety during morcellation. Further studies are necessary to evaluate the influence of the bag on operating time, intervention costs and complications.

Comparison of the trapezius and the adductor pollicis muscle as predictor of good intubating conditions: a randomized controlled trial.

BACKGROUND: Adequate muscle relaxation is important for ensuring optimal conditions for intubation. Although acceleromyography of the adductor pollicis muscle is commonly used to assess conditions for intubation, we hypothesized that acceleromyography of the trapezius is more indicative of optimal intubating conditions. The primary outcome was the difference between both measurement sites with regard to prediction of good or acceptable intubating conditions. METHODS: Neuromuscular blockade after injection of rocuronium 0.3 mg/kg IV was measured simultaneously with acceleromyography of the adductor pollicis muscle and the trapezius muscle in sixty female patients, American Society of Anesthesiologists physical status I to III, undergoing general anesthesia for gynecologic surgery. Exclusion criteria were: expected difficult tracheal intubation (e.g. history of difficult intubation, reduced mouth opening (< 2 cm) and/or Mallampati Score 4), increased risk of pulmonary aspiration (e.g. gastroesophageal reflux or delayed gastric emptying) allergies to drugs used during the study, pregnancy, neuromuscular diseases, medication with potential to influence neuromuscular function (e.g. furosemide, magnesium, cephalosporins) and hepatic or renal insufficiency (serum bilirubin >26 µmol/L, serum creatinine >90 µmol/l). Patients were randomized to 2 groups: group A (n = 30): endotracheal intubation after onset of the neuromuscular block at the adductor pollicis muscle. Group B (n = 30): endotracheal intubation after onset at the trapezius muscle. Intubating conditions were compared between both groups by means of a standardised score (the Copenhagen score) with Fisher's exact test. RESULTS: Onset of the block after rocuronium injection was observed at the adductor pollicis muscle compared to the trapezius with 2.8 (1.1) versus 2.5 (1.1) min (mean ± SD; P = 0.006). Intubating conditions were poor in 2 patients (7%) of group A, and in 1 patient (3%) of group T. They were acceptable (either excellent or good) in 28 patients (93%) in group A, and in 1 patient (97%) in group T (P = 0.82). CONCLUSIONS: Performing acceleromyography at the trapezius muscle reduced the time between injection of neuromuscular blocking agents and intubation by 18 s (11%). Thus, trapezius muscle acceleromyography is an acceptable alternative to adductor pollicis muscle acceleromyography in predicting acceptable intubating conditions, which allows for earlier indication of adequate intubating conditions. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT01849198 . Registered April 29, 2013.

Monitoring recovery from rocuronium-induced neuromuscular block using acceleromyography at the trapezius versus the adductor pollicis muscle: an observational trial.

PURPOSE: Positioning for surgery can restrict access to the patient's hand, thereby limiting assessment of the response at the adductor pollicis muscle to ulnar nerve stimulation. We evaluated a novel site to assess neuromuscular block by stimulating the accessory nerve and measuring the acceleromyographic response at the trapezius muscle. METHODS: In this prospective non-blinded observational study, we assessed neuromuscular transmission in anesthetized adult female patients undergoing elective laparoscopic gynecological surgery. We performed the assessment by simultaneous recording acceleromyographic responses with the TOF-Watch(®) SX monitor at both the right adductor pollicis and left trapezius muscles. The neuromuscular block was achieved using rocuronium 0.3 mg·kg(-1), and the repeatability, time course, and limits of agreement (Bland-Altman) of responses were compared at the two recording sites. The primary endpoint was the 90% train-of-four (TOF) recovery time with other endpoints included the onset time of the block, maximum T1 depression, time to 25% T1 recovery, and recovery time course of the T1 response and TOF ratio. RESULTS: Thirty-six patients were enrolled with responses obtained from 27 subjects. The variability of baseline responses recorded at the trapezius muscle was larger than that recorded at the adductor pollicis muscle, as determined by their mean (SD) repeatability coefficients [twitch height T1, 6.1 (1.9)% and 4.2 (1.6)%, respectively; P = 0.001; TOF ratio, 6.2 (2.1)% and 4.3 (1.7)%, respectively; P = 0.001]. The recorded responses showed relatively narrow limits of agreement. The onset time of the block was 0.3 min earlier at the trapezius muscle than at the adductor pollicis muscle [2.3 (0.8) min and 2.6 (0.7) min, respectively; P = 0.007], with limits of agreement ranging from 1.6 min earlier to 1.0 min later. The time to 25% T1 recovery was 1.8 min earlier at the trapezius muscle than at the adductor pollicis muscle [18.2 (5.7) min and 20.0 (5.2) min, respectively; P = 0.039], with limits of agreement ranging from 11.1 min earlier to 7.5 min later. Additionally, the time to achieve 90% TOF ratio was 4.4 min earlier at the trapezius muscle than at the adductor pollicis muscle [32.6 (7.9) min and 37 (9.1) min, respectively; P = 0.004], with limits of agreement ranging from 18.4 min earlier to 9.7 min later. CONCLUSIONS: We conclude that recording evoked acceleromyographic responses at the trapezius muscle is an acceptable alternative when monitoring from the adductor pollicis muscle is compromised. Nevertheless, we caution that recording a 90% TOF response at the trapezius muscle may overestimate functional recovery from the neuromuscular blockade. This trial was registered at ClinicalTrials.gov identifier, NCT01849198.

Intermittent versus continuous sciatic block combined with femoral block for patients undergoing knee arthroplasty. A randomized controlled trial.

PURPOSE: Many institutions perform peripheral femoral and/or sciatic nerve blocks for analgesia after total knee arthroplasty. The aim of the present investigation was to compare the analgesic effect of an intermittent sciatic block (boluses on demand only) with a continuous infusion. METHODS: One hundred and forty patients receiving a femoral and a sciatic nerve block (SNB) by catheter were assessed. The femoral catheter was infused continuously in both groups. In the continuous group (n = 70), the sciatic catheter was used continuously as well. In the intermittent group (n = 70), after a single injection of 20 ml ropivacaine 0.75 %, injections into the sciatic catheter were performed on demand only. Frequency of injections, ventral and dorsal numerical pain scores (NRSs) of the knee, functional outcome (degree of flexion/extension) and additional opioid requirements were assessed during the post-operative period. RESULTS: In both groups, dorsal and ventral NRSs were below 3 at rest and below 5 during mobilisation over the complete period of assessment. Differences between the groups could not be observed. The cumulative number of supplemental injections into the sciatic catheter was higher in the intermittent group (52) compared with the continuous group (24; p < 0.05). Groups did not differ from each other with regard to functional outcome and opioid consumption. CONCLUSIONS: The use of a sciatic block performed as intermittent bolus injection on demand only did not affect post-operative outcome parameters with regard to pain scores, functional outcome or opioid requirements. This approach might therefore be considered as an alternative to a continuous infusion concept. ClinicalTrials.gov Identifier: NCT01843153.

Power morcellation inside a secure endobag: a pilot study.

INTRODUCTION: Unprotected power morcellation can lead to a spread of previously undiagnosed malignancy. We present a new containment bag with two closable trocar insertion sites to reduce this risk. This pilot study was designed to assess the feasibility of this device under everyday conditions. MATERIAL AND METHODS: The containment bag was used in ten laparoscopic supracervical hysterectomies. We evaluated time requirement for bag insertion into the abdominal cavity and in-bag morcellation. A 2000 ml polyurethane morcellation bag was used for all interventions. All surgeries were carried out in a three-trocar setting. RESULTS: We carried out ten supracervical hysterectomies. No intraoperative complications and no bag ruptures occurred. The meantime requirement to insert the bag and prepare the specimen for morcellation was 10.5 min (range, 7-19 min). The mean specimen weight was 191.9 g (range, 32-710 g). Mean morcellation time was 10.5 min (range, 3-28 min), mean weight of remaining tissue and fluid in the bag after morcellation was 12.1 g (range, 7-19 g). CONCLUSIONS: The presented data demonstrate that the endobag can be successfully applied in the clinical routine. Further studies are required to evaluate additional characteristics, such as individual learning curve and time requirements.

Value of clinical and laboratory inflammation factors in the postoperative period after laparoscopic urogynecological surgery.

BACKGROUND/AIMS: Leukocytes and C-reactive protein (CRP) levels are often used to detect infections. The aim of this study was to evaluate the diagnostic and screening validity of leukocytes and CRP levels as well as body temperature >38° C to predict infections after laparoscopic sacrocolpopexy. METHODS: The study included 287 patients suffering from genital prolapse higher than POP-Q I. In addition to the sacrocolpopexy, a laparoscopic supracervical hysterectomy was performed in cases of preexisting uterus (n = 171). Leukocytes and CRP levels were analyzed preoperatively and 4 days after surgery. Early and late onset of infections was documented. RESULTS: Urinary tract infection was identified as the most frequent early postoperative complication (11.4%). Early wound infections were found in 2.8% of the patients (8/287). Late onset of infections was found in 1% of patients (3/287). Areas under ROC curves were low for both leukocytes (0.52, 95% CI: 0.37-0.66) and CRP levels (0.60, 95% CI: 0.44-0.77). CONCLUSION: Our findings question the benefit of routine determination of leukocytes and CRP levels 4 days after surgery. The sensitivity and specificity of leukocytes and CRP levels are probably more significant after normalization of the initial tissue response (days 8-10).

Dexamethasone decreases the duration of rocuronium-induced neuromuscular block: a randomised controlled study.

BACKGROUND: Several drugs influence the time course of neuromuscular block during general anaesthesia. OBJECTIVE: To evaluate the effect of a single dose of dexamethasone 8 mg on the time course of a rocuronium-induced neuromuscular block. DESIGN: A randomised controlled, unblinded, monocentre trial. SETTING: Kreiskrankenhaus Dormagen, Dormagen, Germany. PATIENTS: One hundred and eight adult patients scheduled for elective gynaecological laparoscopic surgery allocated to three groups. INTERVENTIONS: Patients received dexamethasone 8 mg intravenously 2 to 3 h prior to surgery (Group A), during induction of anaesthesia (Group B) or after recovery of the neuromuscular block (Group C, control). MAIN OUTCOME MEASURES: The time course of the neuromuscular block of rocuronium 0.3 mg kg was assessed using acceleromyography. The primary end point was the time from start of injection of rocuronium until recovery to a train-of-four ratio of 0.9. RESULTS: The clinical duration was decreased in Group A (15.8 ±â€Š4.5 min) compared with Group B (18.7 ±â€Š5.8 min; P = 0.031). The recovery index was reduced in Group A (6.8 ±â€Š1.8 min) compared with Group B (8.1 ±â€Š2.6 min; P = 0.018) and Group C (8.3 ±â€Š2.8 min; P = 0.01). The recovery to a train-of-four ratio of 0.9 was shorter in Group A (30.4 ±â€Š6.9 min) than in Groups B (36.3 ±â€Š10.7 min; P = 0.031) and C (36.8 ±â€Š11.3 min; P = 0.02). CONCLUSION: A single dose of dexamethasone 8 mg attenuated rocuronium-induced block by 15 to 20% if administered 2 to 3 h prior to induction of anaesthesia. However, the administration of dexamethasone during induction of anaesthesia did not influence the time course of the neuromuscular block. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT01782820.

Randomized evaluation of the size 2 laryngeal tube and classical laryngeal mask airway in different head and neck positions in children under positive pressure ventilation.

PURPOSE: The aim of this study was to evaluate the applicability of the laryngeal tube (LT) size 2 and the classical laryngeal mask airway (LMA) size 2 in different head-neck positions under positive pressure ventilation in children by measuring leak pressures, peak pressures and the achievable tidal volumes under positive pressure ventilation. METHODS: Forty children were randomized to receive airway management by either the LT or LMA as the primary device. Leak pressures, peak pressures and tidal volumes under positive pressure ventilation were measured in the neutral, anteflection, retroversion, left-rotation and right-rotation head-neck positions. RESULTS: In all head-neck positions, the leak pressures were significantly higher for the LT than for the LMA (neutral 25.9 ± 7.0 vs. 19.1 ± 5.7 cmH2O; anteflection 29.7 ± 7.1 vs. 24.2 ± 8.9 cmH2O; retroversion 24.1 ± 7.6 vs. 17.2 ± 6.9 cmH2O). In both devices, the peak ventilation pressures were higher in the anteflection position (LT 27.1 ± 6.3 cmH2O; LMA 17.8 ± 6.7 cmH2O) than in the retroversion position (LT 13.7 ± 3.9 cmH2O; LMA 12.7 ± 3.6 cmH2O). Compared to the respirator settings, lower tidal volumes were achieved in the anteflection position (LT 65 ± 48 vs. 129 ± 38 ml, LMA 100 ± 21 vs. 125 ± 29 ml) as compared to the other positions. CONCLUSION: Based on our results, we suggest that in anaesthetized children, the size 2 LT, compared to the size 2 LMA, may be more suitable for positive pressure ventilation due to favorable leak and peak pressures. Both devices can be safely used in head-neck positions other than neutral. Most disadvantageous with regards to the measured parameters was the anteflection position, especially for the LT.

Assessment of the New Acceleromyograph TOF 3D Compared with the Established TOF Watch SX: Bland-Altman Analysis of the Precision and Limits of Agreement between Both Devices-A Randomized Clinical Comparison.

The new acceleromyograph TOF 3D was compared with the established TOF Watch SX in patients undergoing elective laparoscopic gynecological surgery. Neuromuscular transmission was assessed by simultaneous recording with both devices. Measurements were performed simultaneously at the left and the right M. adductor pollicis (Group A, 25 patients), or the M. corrugator supercilii (Group CS, 25 patients). The repeatability, time course, and limits of agreement (Bland-Altman) were compared. The primary endpoint was the 90% train-of-four recovery time (TOFR 0.9). Other endpoints included onset time of block, maximum T1 depression, time to 25% T1 recovery, the recovery time course of T1 response, and TOF ratio, respectively. In group CS, the repeatability coefficient of the TOF 3D was lower (4.66 (1.6)) than of the TOF Watch SX (6.02 (1.9); p = 0.026). In group A, the onset of the block was faster when measured by the TOF 3D (98.7 (30) s vs. 112.2 (36) s (mean (SD)); p = 0.032). In group A, time to recovery to a TOFR of 90% was measured earlier by the TOF 3D (bias -0.71 min, limits of agreement from -8.94 to +7.51 min). The TOF 3D provides adequate information with high precision and sensitivity. It is suitable even for measurement sites with small muscle contractions such as the M. corrugator supercilii.

The influence of residual neuromuscular block on the incidence of critical respiratory events. A randomised, prospective, placebo-controlled trial.

CONTEXT: Residual paralysis is associated with post-operative pulmonary complications, including critical respiratory events. OBJECTIVE: We determined the incidence of critical respiratory events, such as hypoxaemia, in patients with minimal residual neuromuscular blockade and compared these data with those from patients with full recovery of blockade. DESIGN: Randomised, prospective, placebo-controlled trial. SETTING: Single centre; Rostock, Germany, from January 2007 to February 2008. PATIENTS: One hundred and thirty-two adult patients, aged 18-80 years, with the American Society of Anesthesiology I-III physical status, undergoing orthopaedic surgery under general anaesthesia, including rocuronium to produce neuromuscular blockade; 114 patients were randomised to one of two groups: neostigmine group (neostigmine 20 µg kg-1) or placebo group (saline). INTERVENTIONS: In the patients in the neostigmine group, the tracheal tube was removed at a train-of-four (TOF) ratio of 1.0; in the patients in the placebo group, the trachea was extubated at a TOF ratio less than 1.0, but without fade in TOF and double-burst stimulation (DBS). Neuromuscular monitoring was assessed simultaneously with qualitative TOF/DBS monitoring, and with quantitative calibrated acceleromyography. Critical respiratory events, such as hypoxaemia, were assessed in the post-anaesthesia care unit. MAIN OUTCOME MEASURES: Forty-five patients (39.5%) became hypoxaemic (SaO2 < 93%); there was a significant difference between the groups (29 patients in the placebo group versus 16 in the neostigmine group; P = 0.021). RESULTS: In the neostigmine group, all patients were extubated at a TOF ratio of 1.0. In the placebo group, the median TOF ratio was 0.7 (range: 0.46-0.9; P < 0.001). The median time for spontaneous recovery in the placebo group was 16 min (range 3-49 min). Neostigmine 20 µg kg was effective in antagonising rocuronium-induced blockade without fade in TOF and DBS. CONCLUSION: In this randomised, prospective, placebo-controlled trial, minimal residual block was associated with hypoxaemia in the post-anaesthesia care unit. Neostigmine 20 µg kg was effective in antagonising rocuronium-induced (minimal) blockade.

Preclinical safety testing and initial experience of a morcellation bag with four sealable ports.

Electromechanical morcellation-so called power morcellation-is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11-24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4-14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20-194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13-896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0-39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies.

Depth of Neuromuscular Block Is Not Associated with Abdominal Wall Distention or Surgical Conditions during Gynecologic Laparoscopic Operations. A Prospective Trial.

The influence of the degree of a neuromuscular block (NMB) on surgical operating conditions during laparoscopic surgery is debated controversially. The extent of abdominal distension during the time course of the NMB was assessed as a new measurement tool. In 60 patients scheduled for gynecologic laparoscopic surgery, the increase of the abdominal wall length induced by the capnoperitoneum was measured at 5 degrees of the NMB: intense NMB-post-tetanic count (PTC) = 0; deep NMB-train-of-four count (TOF) = 0 and PTC = 1-5; medium NMB-PTC > 5 and TOF = 0-1; shallow NMB-TOF > 1; full recovery-train-of-four ratio TOFR > 90%. Simultaneously, the quality of operating conditions was assessed with a standardized rating scale (SRS) reaching from 1 (extremely poor conditions) to 5 (excellent conditions). Fifty patients could be included in the analysis. The abdominal wall length increased by 10-13 mm induced by the capnoperitoneum. SRS was higher during intense NMB (4.7 ± 0.5) vs. full recovery (4.5 ± 0.5) (mean ± SD; p = 0.025). Generally, an intense NMB did not increase abdominal wall length induced by capnoperitoneum. Additionally, its influence on the quality of surgical operating conditions seems to be of minor clinical relevance.

Parecoxib versus dipyrone (metamizole) for postoperative pain relief after hysterectomy : a prospective, single-centre, randomized, double-blind trial.

BACKGROUND AND OBJECTIVE: Selective cyclo-oxygenase-2 (COX-2) inhibitors provide postoperative pain relief similar to conventional NSAIDs. However, many of these non-opioid analgesics are available only for oral administration, and are therefore ineffective in patients experiencing postoperative nausea or vomiting. The aim of this study was to compare the analgesic efficacy of the COX-2 inhibitor parecoxib with that of dipyrone (metamizole) administered intravenously for 48 hours after vaginal hysterectomy. METHODS: Fifty women undergoing vaginal hysterectomy under general anaesthesia were randomly assigned to two groups: the parecoxib group, who received intravenous parecoxib 40 mg intraoperatively and every 12 hours after surgery over a period of 48 hours, and the dipyrone group, who received intravenous dipyrone 2.5 g injected intraoperatively, followed by dipyrone 1 g every 6 hours after surgery over a period of 48 hours. Because of the double-blinded study protocol, patients in the parecoxib groups were required to receive placebo infusions 6, 18, 30 and 42 hours after the operation. Visual analogue scale (VAS [scale 0-10]) scores were recorded 0.5, 1, 2, 3, 4, 6, 9, 12, 15, 18, 24, 36 and 48 hours after surgery. To assess the cumulative opioid administration, all patients were fitted with an intravenous patient-controlled analgesia (PCA) device containing the opioid piritramide. An alpha value of 0.05 was considered statistically significant. RESULTS: VAS scores did not differ between groups with one exception: VAS scores were lower in the parecoxib group 12 hours after surgery than in the dipyrone group (1 and 2, respectively; p < 0.05). No significant differences in cumulative piritramide administration were measured between groups 1 hour or 24 hours after surgery (parecoxib 14.7 [+/- SD 4.4] and 30.6 [+/- 12.8] mg, respectively; dipyrone 11.8 [+/- 4.9] and 36.5 [+/- 10.7] mg, respectively). CONCLUSIONS: Parecoxib 40 mg twice daily provides postoperative pain relief equivalent to that of dipyrone 4 g daily during the first 48 hours in patients after hysterectomy.

Sevoflurane at 1.0 MAC together with remifentanil and propofol produces clinically acceptable intubation conditions at the vocal cords: A prospective randomized study.

Objective The overall intubation conditions after tracheal intubation with remifentanil, propofol, and sevoflurane at 1.0 minimum alveolar concentration (MAC) are worse than with rocuronium at 0.45 mg/kg. Therefore, we compared the intubation conditions and laryngeal morbidity (vocal cord injuries, hoarseness, and sore throat) with sevoflurane at 1.2 and 1.4 MAC versus 1.0 MAC. Methods In this prospective clinical trial, 90 patients were randomized to 3 groups: the sevoflurane 1.0, 1.2, and 1.4 MAC groups. At 3 min, tracheal intubation was performed and the patients' intubation conditions were assessed. The vocal cords were examined for injury by videolaryngoscopy. Additionally, the incidence and severity of laryngeal morbidity were compared between women and men. Results Acceptable intubation conditions were seen in 72% of the patients without significant differences between the groups. Overall, vocal cord injuries (oedema) occurred in three (4%) patients. Women reported sore throat more often than men (51% vs. 21%, respectively). Conclusions Intubation conditions were not improved with higher sevoflurane concentrations. The incidence and severity of sore throat were greater in women than men. TRIAL REGISTRATION: ClinicalTrials.Gov: NCT 01896245.