Abeer Ahmed

Citation:

Ahmed, A., D. Saad, and Abdel Rahman Youness, "Superior Laryngeal Nerve block as an adjuvant to General Anesthesia during endoscopic laryngeal surgeries. A randomized controlled trial.", Egyptian Journal of Anaesthesia , vol. 31, pp. 167-174, 2015.

Abstract:

Background: Direct rigid endoscopic laryngosurgery is a short procedure usually performed
under general anesthesia. This is a double blinded randomized placebo-controlled trial, that was
designed to evaluate the effect of bilateral block of the internal branch of superior laryngeal nerve
(SLN) as an adjuvant to general anesthesia during endoscopic laryngeal surgery when smaller dose of
muscle relaxant is used.
Method: Seventy-six patients required endoscopic laryngosurgery in whom general anesthesia was
preceded by bilateral superior laryngeal nerve block either with 2%lidocaine (L-group) or with saline
(C- group).
Results: the reaction to endotracheal tube insertion was better in L-group as less frequent cough
occurred in L-group (one patient) compared with (8 patients) in C-group (P value < 0.05). The
maximum pressor response was observed immediately after intubation, at which the increase in MAP
from baseline in C-group (24.4%) was significantly higher than in L-group (6.4%) (P<0.05) and the
increase in HR from baseline in C-group (29.5 %) was significantly higher than in L- group (14.8 %)
(P<0.05). The MAP and HR remain significantly higher in C-group than that of the L-group all through
the intraoperative period. The incidence of severe cough was significantly higher in C-group just before
extubation (bucking), 5min & 30 minutes post extubation. Incidence and severity of postoperative sore
throat was significantly higher in C-group in the first 4 hours postoperatively.
Conclusion: During endoscopic laryngeal surgeries,using bilateral block of the internal branch of
superior laryngeal nerve as an adjuvant to general anesthesia was associated with better intubation
conditions, better intraoperative hemodynamic response to intubation and surgical procedure and
better recovery profile in form of improved postoperative cough and sore throat.