A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 %) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 % of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.

Original languageEnglish (US)
Pages (from-to)1-4
Number of pages4
JournalJournal of Anesthesia
DOIs
StateAccepted/In press - Aug 13 2016

Fingerprint

Vocal Cords
Paralysis
Anesthesia
Laryngoplasty
Analgesia
General Anesthesia
Dexmedetomidine
Neck
Airway Extubation
Anesthesia and Analgesia
Local Anesthesia
Intubation

Keywords

  • Arytenoid adduction
  • Dexmedetomidine
  • Remifentanil
  • Thyroplasty
  • Vocal fold paralysis

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine

Cite this

@article{1be0b420845042eebfc30ff48a0160a4,
title = "A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis",
abstract = "Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 {\%}) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 {\%} of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 {\%} of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.",
keywords = "Arytenoid adduction, Dexmedetomidine, Remifentanil, Thyroplasty, Vocal fold paralysis",
author = "Rosero, {Eric B.} and Esra Ozayar and Ted Mau and Joshi, {Girish P.}",
year = "2016",
month = "8",
day = "13",
doi = "10.1007/s00540-016-2231-0",
language = "English (US)",
pages = "1--4",
journal = "Journal of Anesthesia",
issn = "0913-8668",
publisher = "Springer Japan",

}

TY - JOUR

T1 - A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis

AU - Rosero, Eric B.

AU - Ozayar, Esra

AU - Mau, Ted

AU - Joshi, Girish P.

PY - 2016/8/13

Y1 - 2016/8/13

N2 - Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 %) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 % of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.

AB - Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 %) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 % of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.

KW - Arytenoid adduction

KW - Dexmedetomidine

KW - Remifentanil

KW - Thyroplasty

KW - Vocal fold paralysis

UR - http://www.scopus.com/inward/record.url?scp=84982106585&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84982106585&partnerID=8YFLogxK

U2 - 10.1007/s00540-016-2231-0

DO - 10.1007/s00540-016-2231-0

M3 - Article

C2 - 27522215

AN - SCOPUS:84982106585

SP - 1

EP - 4

JO - Journal of Anesthesia

JF - Journal of Anesthesia

SN - 0913-8668

ER -