Airway Considerations for Professional Singers—A Survey of Expert Opinion

Powner, David J.

doi:10.1016/s0892-1997(02)00124-8

Cited by 14 publications

(5 citation statements)

References 16 publications

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“…The use of antacids during induction and investing in prophylaxis against nausea and vomiting are fundamental. 3,5 This context shows the importance of systematic post-anaesthetic follow-up with patients, useful to document the state of the voice, assessing temporary post-operative changes in timbre, range and phonation time.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are few guidelines for standardised anaesthetic practices, and the current evidence is based on joint opinions issued by specialists. 5 In the clinical case being studied, it is important to note that the surgery was related to the abdomen, a structure that plays an essential role in the performance and cinematic aspects of classical singers and post-operative abdominal pain proves decisive for vocal respiratory support. 3 This article aims to review the best anaesthetic approach for voice professionals, based on a practical case.…”

Section: Introductionmentioning

confidence: 99%

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Voice professionals and associated anaesthetic risk: a proposal to a perioperative airway-protective care bundle

Fonseca¹,

Silva²,

Bento³

et al. 2018

JACCOA

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Background: Voice professionals subjected to surgical procedures or anaesthesia are particularly susceptible, considering the multi-factor potential for damaging the vocal system. Such injuries are the most common reasons for anaesthetic morbidity and have even more serious repercussions for singers. Surgery in the abdominal region is singularly important, considering the vital role that abdominal support plays for respiratory dynamics and vocalisation. Perioperative management and planning and strict anaesthetic practices are fundamental for minimising this risk and promoting an optimum clinical outcome. The lack of guidelines adapted to this context justifies the need to gather together and review all existing evidence, which this case study aims to do. Case presentation: The clinical case concerns a 46year old female, a light opera singer, admitted for laparoscopic cholecystectomy. It describes the ample pre-anaesthetic assessment and education and lists the protective technical and pharmacological choices adopted during the surgery. The subsequent follow-up serves as the starting point for reflecting on the results obtained, preparing a suggested sequential approach for each perioperative stage. Conclusion: Even though vocal damage depends on the surgical and anaesthetic approach during the operation, anaesthesia for voice professionals requires rigorous planning beforehand, often being more complex than the surgical procedure. A multifaceted intervention including counselling, less invasive anaesthetic practices and systematic follow-up promote the key strategy – overall protection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Voice professionals and associated anaesthetic risk: a proposal to a perioperative airway-protective care bundle

Fonseca¹,

Silva²,

Bento³

et al. 2018

JACCOA

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“…Usually females liked singing more than males (p = 0.026), nevertheless in 24 hours after extubation singing males were more sensitive to throat pain (p < 0.001). It proves the fact that vocal cords are very sensitive anatomic structures, therefore intubation should be more delicate for professional singers: in order to avoid even slight mucosal traumatizing, the tube size should be smaller (7.0 for males and 6.0 for females) than usual and intubation should be performed by the experienced anesthesiologist (22).…”

Section: Discussionmentioning

confidence: 99%

Laryngopharyngeal complaints following short-term endotracheal intubation: peculiarities of males and females

Paulauskienė¹,

Lesinskas²

2012

AML

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Background. Laryngopharyngeal complaints are classified as minor post-intubation complications. They cause great discomfort, have some influence on the quality of life and can limit patient's casual activity. The extent of complaints ranges from 12 to 65%. Undesirable complications can be avoided by ascertaining factors that are able to provoke or decrease laryngopharyngeal symptoms after endotracheal intubation. In this study, we assessed predominant laryngopharyngeal symptoms following a short-term endotracheal intubation and their peculiarities subject to gender, and we estimated the most important influencing factors.Materials and methods. 218 patients were examined before endotracheal anesthesia, 1-2 and 24 hours after extubation. The following laryngopharyngeal complaints were recorded: hoarseness, vocal fatigue, globus pharyngeus, throat pain and throat clearing. These factors were also assessed in relation to endotracheal intubation parameters: endotracheal tube size, cuff volume and pressure, number of intubation attempts, length of anesthesia, experience of anesthesiologist and additional parameters: smoking, allergy, GERD symptoms, laryngitis and singing skills subject to gender.Results. All laryngopharyngeal symptoms increased significantly in 2 hours after extubation and remained increased after 24 hours in both male and female groups. In 1-2 hours after extubation, females complained of throat pain more than males (61.3 vs. 42.9%; p = 0,014). The following significant relations were found 1-2 hours after extubation: between throat pain and length of anesthesia, globus pharyngeus and tube size and cuff volume in the male group; between globus pharyngeus, vocal fatigue and smoking, throat clearing and cuff volume in the female group. After 24 hours, the relation was noticed between vocal fatigue and cuff volume and number of intubation attempts, globus pharyngeus and length of anesthesia, between hoarseness and number of intubation attempts and between throat pain and singing skills in the male group. Some relation between throat clearing and cuff volume remained for 24 hours after extubation, smoking had influence on hoarseness and vocal fatigue in the female group.Conclusions. Laryngopharyngeal symptoms remain an important cause of discomfort for 24 hours after extubation. Females complain of laryngeal and pharyngeal symptoms more than males and throat pain following extubation is also more frequent in females. The most important parameters of short-term endotracheal intubation that influence laryngopharyngeal complaints are as follows: cuff volume, length of anesthesia and number of intubation attempts that affect males more than females. Smoking affects females more, though singing skills are more significant in the male group.

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“…A number of small studies have investigated the anaesthetic factors affecting vocal cord function perioperatively [98]. Some experts advocate the use of smaller tubes in the peri-operative setting when treating professional singers for this reason [99], but the evidence is limited. An observational study found the size of the tube may result in minor changes in pitch and vocal fatigue, as well as a sensation of a lump in the throat, globus pharyngeus [100].…”

Section: Peri-operative Airway Injurymentioning

confidence: 99%

Tracheal tube size in adults undergoing elective surgery – a narrative review

Karmali

Rose

2020

Anaesthesia

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Tracheal tubes are routinely used in adults undergoing elective surgery. The size of the tracheal tube, defined by its internal diameter, is often generically selected according to sex, with 7-7.5 mm and 8-8.5 mm tubes recommended in women and men, respectively. Tracheal diameter in adults is highly variable, being narrowest at the subglottis, and is affected by height and sex. The outer diameter of routinely used tracheal tubes may exceed these dimensions, traumatise the airway and increase the risk of postoperative sore throat and hoarseness. These complications disproportionately affect women and may be mitigated by using smaller tracheal tubes (6-6.5 mm). Patient safety concerns about using small tracheal tubes are based on critical care populations undergoing prolonged periods of tracheal intubation and not patients undergoing elective surgery. The internal diameter of the tube corresponds to its clinical utility. Tracheal tubes as small as 6.0 mm will accommodate routinely used intubation aids, suction devices and slim-line fibreoptic bronchoscopes. Positive pressure ventilation may be performed without increasing the risk of ventilator-induced lung injury or air trapping, even when high minute volumes are required. There is also no demonstrable increased risk of aspiration or cuff pressure damage when using smaller tracheal tubes. Small tracheal tubes may not be safe in all patients, such as those with high secretion loads and airflow limitation. A balanced view of risks and benefits should be taken appropriate to the clinical context, to select the smallest tracheal tube that permits safe perioperative management.

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Airway Considerations for Professional Singers—A Survey of Expert Opinion

Cited by 14 publications

References 16 publications

Voice professionals and associated anaesthetic risk: a proposal to a perioperative airway-protective care bundle

Voice professionals and associated anaesthetic risk: a proposal to a perioperative airway-protective care bundle

Laryngopharyngeal complaints following short-term endotracheal intubation: peculiarities of males and females

Tracheal tube size in adults undergoing elective surgery – a narrative review

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