Video laryngoscopy: indications, technique, complications
A laryngoscopy refers to a method of examination in which it is possible to determine the physiological and pathological condition of the larynx. Depending on the starting point of research, this methodology is divided into: indirect, direct and retrograde. Video laryngoscopy, as well as other types, is used not only for diagnosis but also for treatment of pathologies of the laryngeal region.
Given the clinical picture, the manipulation may undertake an otolaryngologist or anesthesiologist. In the direct method of laryngoscopy, the patient throws back her head, allowing you to create a single direction between the oral and laryngeal area. Then introduce a laryngoscope – an instrument equipped with light sensor. Using the blade of the instrument, the doctor can push back and to highlight certain areas of the larynx that allows you to visually assess the condition of individual parts of the body. Often laryngoscopy the direct method is applied during intubation of the trachea.
- Blood cough or expectoration.
- Violation of swallowing, and foreign body sensation in the laryngeal region.
- Pain in ear and laryngeal areas.
- The lack of breath.
Laryngoscopy is also indicated in injuries to the laryngeal region.
But most often the use of direct methods, namely microlaryngoscopy, used in the diagnosis and treatment of tumors, biopsy, removal of foreign bodies, laser surgery.
Using this method is also relevant in the treatment of interlocking vocal cords and stenosis of the respiratory tract.
The use of direct laryngoscopy is not possible in every patient and contraindicated in the following cases:
- Cardiovascular disease: hypertension, stroke, heart attack, aortic aneurysm, malformations and others.
- Disease progresses respiratory and digestive tract: acute inflammation in the nasal cavity, oropharynx and larynx.
- Stenotic breathing pronounced degree.
To the relative constraints in which direct laryngoscopy cannot be performed, is an allergic reaction to drugs used during the survey. To confirm the Allergy and selection of the substitution medication the patient is allergic to test the sensitivity to applied during laryngoscopy drugs. About the presence of drug intolerance, you must notify your doctor at the first appointment for the disease, as well as when filling out the questionnaire of health, all allergies must be specified somatic diseases in women pregnancy. An important point is that the men of hemophilia and prolonged clotting time. When medication is necessary to note not only the appearance, but also the course of treatment with medication.
In order to was performed a direct laryngoscopy, before the passing of the examination, the patient must first be prepared. The last meal and liquids must be made no later than 8 hours prior to laryngoscopy. To the consultation before laryngoscopy, the patient should be explained what the purpose is manipulation, and obtained written permission from the patient or next of kin.
The patient should know that shortly before laryngoscopy it should take sedatives to relax the nervous system, and drugs that reduce the secretion of mucus in the respiratory tract (atropine). On the application of local anesthetic the area of the larynx and that the device will not affect the patient’s breathing should also be known.
1 hour or 30 minute the patient is administered sedatives. Before taking medicines you must remove dentures, contact lenses, jewelry. Before laryngoscopy should also urinate. Since the survey in some cases is performed under General anesthesia, before administration it is carried out to determine the physiological parameters of the body: the respiratory frequency and heart rate, heart rate, supplementing them with other data if necessary.
The procedure for direct laryngoscopy:
- Orthoscope the patient in the supine position, arms along the body.
- Irrigate mouth with solutions of anesthetics.
- The introduction of a laryngoscope examination of the larynx.
- Perform a biopsy, removing, and retrieving entities.
- Monitoring the condition of the patient, applying a compress with the cold in the area of the larynx.
After was withdrawn from the oral cavity material, it should be subjected to pathomorphological research. For this purpose it is placed in a sterile container with a special solution and sent to the laboratory. The foreign body must conform to the descriptions obtained by collecting complaints and conducting preliminary x-ray examination.
If the patient is conscious, after the examination or treatment of his stack on a side in the position of the Fowler. Next set the pelvis in case of accidental vomiting. To prevent bleeding, the patient is recommended to suppress the cough reflex. If the patient often spits out saliva with blood content, then the doctor should be informed.
Once was a direct laryngoscopy with the use of anesthesia, it is necessary to slightly raise the head of the patient to prevent aspiration. Monitoring of the condition of the patient is every 15 minutes. After stabilization of vital signs every 30 minutes for 2 hours, then every hour for 4 hours and then every 4 hours during the day. When the complications used in the process of laryngoscopy medication, the nurse needs urgently to inform the doctor. The emergence of crepitate (determined using a stethoscope and palpation examination) in the maxillofacial region may indicate perforation of the trachea and requires urgent medical intervention.
After I restored the gag reflex, after an average of 2 hours from the end of the laryngoscopy, the patient is allowed a meal and liquid. Start with water, drink small SIPS you want. The possible appearance of osiplosti and even loss of voice are temporary. For a more rapid passage of symptoms the patient is prescribed the irrigation of oral cavity with special liquids, and lozenges.