Cardiac complications of microsurgery of the larynx: Etiology, incidence and prevention

Abstract

In no surgical arena is the cooperation and mutual understanding of the anesthesiologist and surgeon more important than in endolaryngeal surgery; here in the narrowest part of the airway, they compete for a share of the limited space available! The anesthesiologist must understand the requirements for optimal operating conditions but more importantly, the surgeon must understand the requirements for safe general anesthesia if unnecessary complications are to be avoided. Cardiac infarction, myocardial ischemia and arrhythmias, may occur during or after microsurgery of the larynx; they are most likely to be precipitated by pressure stimulation of the deep receptors of the larynx during suspension of the laryngoscope. The reflex pathway that produces the arrhythmia includes the superior laryngeal nerve and the cardio‐in‐hibitory fibers of the vagus. It appears that the complications are most often induced by the surgical manipulation and potentiated by abnormal blood gases. A small bore cuffed endotracheal tube appears to be an eminently satisfactory way of providing control of the airway and good operating conditions. The incidence of cardiac complications was studied in 540 patients and found to be 6.8 percent in the high risk group and 1.9 percent in the group without a preoperative history of cardiac disease. These figures are somewhat higher than those reported by Tarhan, et al., in their study of the incidence of myocardial infarction following surgery of various types under general anesthesia. To keep these complications to a minimum, constant vigilance must be maintained by the surgeon and anesthesiologist, especially on the cardiac monitor and airway. If arrhythmias appear, steps must be taken immediately to remove the cause, otherwise myocardial ischemia and infarction are very likely to follow.

Effects of 10% lidocaine spray on arterial pressure increase due to suspension laryngoscopy and cough during extubation

“…This can lead to complications, such as myocardial ischemia, myocardial infarction, and arrhythmia [1]. In one previous study, laryngeal microscopic surgery using suspension laryngoscopy had a higher rate of postoperative cardiac complications compared to other types of surgeries [3]. Thus, serious consideration by anesthesiologist should be given to the perioperative cardiovascular responses such as hypertension and tachycardia owing to suspension laryngoscopy.…”

“…This causes marked cardiovascular responses via irritation of the deep sensory receptors of the larynx [1,2]. An increase of arterial pressure and heart rate caused by suspension laryngoscopy are usually temporary and rarely accompanied by sequelae [3]. Nevertheless, constant intraoperative vigilance is necessary because such increases can be fatal in patients who have hypertension, myocardial ischemia or cerebrovascular disease.…”

Effect of sevoflurane versus propofol-based anesthesia on the hemodynamic response and recovery characteristics in patients undergoing microlaryngeal surgery

“…[1] The need for attenuation of cardiovascular responses and rapid emergence as well represent a dynamic clinical challenge for anesthesiologists. [23] Various anesthetic agents and a number of alternative anesthetic techniques have been tried with varying results.…”

Inzidenz spatelbedingter Nebenwirkungen der Mikrolaryngoskopie

“…zerebrovaskuläre Insulte, besonders brisant [23]. Wenig et al (1986) erörterten, ob kardiovaskuläre Komplikationen während der Stützlaryngosko-pie als "fact or fiction" zu betrachten sind [24].…”

“…Das Spektrum der in der Literatur angegebenen unerwünschten Auswirkungen der Mikrolaryngoskopie (UAM) umfasst neben den allgemein bekannten Gefahren der Zahnschädigung [8] und der Verursachung oropharyngealer und laryngealer Schleimhautläsionen auch Nervenläsionen des N. hypoglossus/ N. lingualis/N. recurrens [1], funktionelle Störungen der Kiefer-und Kopfgelenke [9] und schwerwiegende kardiale Komplikationen, wie Arrhythmien und Myokardischämien [23].…”