Laryngeal sensitivity in the neonatal period: From bench to bedside

Reix, Philippe; St-Hilaire, Marie; Praud, Jean‐Paul

doi:10.1002/ppul.20645

Cited by 34 publications

(17 citation statements)

References 87 publications

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“…LARYNGEAL CHEMOREFLEXES (LCR) are a group of reflexes triggered in mammals by the contact between a gaseous irritant, such as ammonia vapor, or a liquid, such as milk or gastric juice, and receptors of the laryngeal mucosa. These reflexes, comprised of laryngeal closure, cough, and swallowing (and arousal if necessary) in a mature organism, constitute a major protection mechanism against tracheal aspiration of liquids (20,22). However, in certain conditions, LCR can conversely be responsible for apneas, bradycardias and hypoxemia.…”

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confidence: 99%

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Effects of simulated reflux laryngitis on laryngeal chemoreflexes in newborn lambs

Carreau

Patural

Samson

et al. 2011

Journal of Applied Physiology

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It has been suggested that reflux laryngitis (RL) is involved in apneas-bradycardias of the newborn. The aim of the present study was to develop a unique RL model in newborn lambs to test the hypothesis that RL enhances the cardiorespiratory components of the laryngeal chemoreflexes (LCR) in the neonatal period. Gastric juice surrogate (2 ml of normal saline solution with HCl pH 2 + pepsin 300 U/ml) (RL group, n = 6) or normal saline (control group, n = 6) was repeatedly injected onto the posterior aspect of the larynx, 3 times a day for 6 consecutive days, via a retrograde catheter introduced into the cervical esophagus. Lambs instilled with gastric juice surrogate presented clinical signs of RL, as well as moderate laryngitis on histological observation. Laryngeal chemoreflexes were thereafter induced during sleep by injection of 0.5 ml of HCl (pH 2), ewe's milk, distilled water or saline into the laryngeal vestibule via a chronic, transcutaneous supraglottal catheter. Overall, RL led to a significantly greater respiratory inhibition compared with the control group during LCR, including longer apnea duration (P = 0.01), lower minimal respiratory rate (P = 0.002), and a more prominent decrease in arterial hemoglobin saturation (SpO(2)) (P = 0.03). No effects were observed on cardiac variables. In conclusion, 1) our unique neonatal ovine model presents clinical and histological characteristics of RL; and 2) the presence of RL in newborn lambs increases the respiratory inhibition observed with LCR, at times leading to severe apneas and desaturations.

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“…However, in certain conditions, LCR can conversely be responsible for apneas, bradycardias and hypoxemia. The latter, while reminiscent of fetal-type LCR, can be so severe that they are likely responsible for a certain proportion of apneas of prematurity, most life-threatening events of infancy and some cases of sudden infant death syndrome (11,13,20,22,31).…”

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confidence: 99%

Effects of simulated reflux laryngitis on laryngeal chemoreflexes in newborn lambs

Carreau

Patural

Samson

et al. 2011

Journal of Applied Physiology

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“…Results from our laboratory's previous study strongly suggest that afferent messages from either central or peripheral chemoreceptors are not involved. Theoretically, the reflex mechanism responsible for glottal narrowing could originate from upper airway receptors, which include pressure, temperature (flow), and drive receptors (15). However, it could as well originate from bronchopulmonary receptors, which include the slow adapting (stretch) receptors, the rapidly adapting pulmonary (or irritant) receptors, and the bronchopulmonary C-fiber endings (22).…”

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Mechanisms of active laryngeal closure during noninvasive intermittent positive pressure ventilation in nonsedated lambs

Roy

Samson²,

Moreau-Bussière³

et al. 2008

Journal of Applied Physiology

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The present study stems from our recent demonstration (Moreau-Bussiere F, Samson N, St-Hilaire M, Reix P, Lafond JR, Nsegbe E, Praud JP. J Appl Physiol 102: 2149-2157, 2007) that a progressive increase in nasal intermittent positive pressure ventilation (nIPPV) leads to active glottal closure in nonsedated, newborn lambs. The aim of the study was to determine whether the mechanisms involved in this glottal narrowing during nIPPV originate from upper airway receptors and/or from bronchopulmonary receptors. Two groups of newborn lambs were chronically instrumented for polysomnographic recording: the first group of five lambs underwent a two-step bilateral thoracic vagotomy using video-assisted thoracoscopic surgery (bilateral vagotomy group), while the second group, composed of six lambs, underwent chronic laryngotracheal separation (isolated upper airway group). A few days later, polysomnographic recordings were performed to assess glottal muscle electromyography during step increases in nIPPV (volume control mode). Results show that active glottal narrowing does not develop when nIPPV is applied on the upper airways only, and that this narrowing is prevented by bilateral vagotomy when nIPPV is applied on intact airways. In conclusion, active glottal narrowing in response to increasing nIPPV originates from bronchopulmonary receptors.

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“…Gastroesophageal and pharyngolaryngeal refluxes are associated with both bradycardia and apnea, and may play a role in acute life threatening events (ALTE) or sudden infant death syndrome (SIDS). In airway management during general anaesthesia the laryngeal reflex can cause bradycardia by vagal stimulation and apnoea (Reix et al, 2007). In procedures especially during induction of anaesthesia, such as intubation, bradycardia and apnoea can be provoked.…”

Section: Airway Relatedmentioning

confidence: 99%