Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique

Charles K. Saadeh, Eric B. Rosero, Girish P. Joshi, Esra Ozayar, Ted Mau

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia. Study Design: Case-control study. Methods: A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA technique were compared with 25 TP-AA controls performed completely under sedation/analgesia. The primary outcome measure was the time under sedation. Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of Voice, and total operative time were secondary outcome measures. Results: With the conventional all-SA anesthetic, the duration of SA was 209±26.3 minutes. With the sequential GA-SA technique, the duration of SA was 79.0±18.9 minutes, a 62.3% reduction (P<0.0001). There was no significant difference in the total operative time (209.5 vs. 200.9 minutes; P=0.42) or in voice outcome. This sequential anesthetic technique has been easily adopted by multiple anesthesiologists and nurse anesthetists at our institution. Conclusion: TP-AA is effectively performed under sequential GA-SA technique with a significant reduction in the duration of time under sedation. This allows the surgeon to perform the technically more challenging part of the surgery under GA, without having to contend with variability in patient tolerance for laryngeal manipulation under sedation.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2017

Fingerprint

Laryngoplasty
Analgesia
General Anesthesia
Anesthetics
Anesthesia and Analgesia
Operative Time
Outcome Assessment (Health Care)
Nurse Anesthetists
Case-Control Studies

Keywords

  • Arytenoid adduction
  • Laryngeal framework surgery
  • Medialization laryngoplasty
  • Moderate sedation
  • Sedation/analgesia
  • Thyroplasty
  • Vocal fold paralysis

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@article{33ff9646c57042fa83cccbfd80591b0e,
title = "Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique",
abstract = "Objective: To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia. Study Design: Case-control study. Methods: A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA technique were compared with 25 TP-AA controls performed completely under sedation/analgesia. The primary outcome measure was the time under sedation. Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of Voice, and total operative time were secondary outcome measures. Results: With the conventional all-SA anesthetic, the duration of SA was 209±26.3 minutes. With the sequential GA-SA technique, the duration of SA was 79.0±18.9 minutes, a 62.3{\%} reduction (P<0.0001). There was no significant difference in the total operative time (209.5 vs. 200.9 minutes; P=0.42) or in voice outcome. This sequential anesthetic technique has been easily adopted by multiple anesthesiologists and nurse anesthetists at our institution. Conclusion: TP-AA is effectively performed under sequential GA-SA technique with a significant reduction in the duration of time under sedation. This allows the surgeon to perform the technically more challenging part of the surgery under GA, without having to contend with variability in patient tolerance for laryngeal manipulation under sedation.",
keywords = "Arytenoid adduction, Laryngeal framework surgery, Medialization laryngoplasty, Moderate sedation, Sedation/analgesia, Thyroplasty, Vocal fold paralysis",
author = "Saadeh, {Charles K.} and Rosero, {Eric B.} and Joshi, {Girish P.} and Esra Ozayar and Ted Mau",
year = "2017",
doi = "10.1002/lary.26743",
language = "English (US)",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique

AU - Saadeh, Charles K.

AU - Rosero, Eric B.

AU - Joshi, Girish P.

AU - Ozayar, Esra

AU - Mau, Ted

PY - 2017

Y1 - 2017

N2 - Objective: To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia. Study Design: Case-control study. Methods: A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA technique were compared with 25 TP-AA controls performed completely under sedation/analgesia. The primary outcome measure was the time under sedation. Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of Voice, and total operative time were secondary outcome measures. Results: With the conventional all-SA anesthetic, the duration of SA was 209±26.3 minutes. With the sequential GA-SA technique, the duration of SA was 79.0±18.9 minutes, a 62.3% reduction (P<0.0001). There was no significant difference in the total operative time (209.5 vs. 200.9 minutes; P=0.42) or in voice outcome. This sequential anesthetic technique has been easily adopted by multiple anesthesiologists and nurse anesthetists at our institution. Conclusion: TP-AA is effectively performed under sequential GA-SA technique with a significant reduction in the duration of time under sedation. This allows the surgeon to perform the technically more challenging part of the surgery under GA, without having to contend with variability in patient tolerance for laryngeal manipulation under sedation.

AB - Objective: To determine the extent to which a sequential anesthetic technique 1) shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) affects the total operative time, and 3) changes the voice outcome compared to TP-AA performed entirely under sedation/analgesia. Study Design: Case-control study. Methods: A new sequential anesthetic technique of performing most of the TP-AA surgery under general anesthesia (GA), followed by transition to sedation/analgesia (SA) for voice assessment, was developed to achieve smooth emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA technique were compared with 25 TP-AA controls performed completely under sedation/analgesia. The primary outcome measure was the time under sedation. Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of Voice, and total operative time were secondary outcome measures. Results: With the conventional all-SA anesthetic, the duration of SA was 209±26.3 minutes. With the sequential GA-SA technique, the duration of SA was 79.0±18.9 minutes, a 62.3% reduction (P<0.0001). There was no significant difference in the total operative time (209.5 vs. 200.9 minutes; P=0.42) or in voice outcome. This sequential anesthetic technique has been easily adopted by multiple anesthesiologists and nurse anesthetists at our institution. Conclusion: TP-AA is effectively performed under sequential GA-SA technique with a significant reduction in the duration of time under sedation. This allows the surgeon to perform the technically more challenging part of the surgery under GA, without having to contend with variability in patient tolerance for laryngeal manipulation under sedation.

KW - Arytenoid adduction

KW - Laryngeal framework surgery

KW - Medialization laryngoplasty

KW - Moderate sedation

KW - Sedation/analgesia

KW - Thyroplasty

KW - Vocal fold paralysis

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