Post‐thyroidectomy vocal cord examination by fibreoscopy aided by the laryngeal mask airway

Maroof, M.; Siddique, Mahmood; Khan, Rashid M.

doi:10.1111/j.1365-2044.1992.tb02238.x

Cited by 15 publications

(18 citation statements)

References 1 publication

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“…[1213] However, its availability, setup, and skill of the operator are major drawbacks in using fiber-optic laryngoscopy on a routine basis for all thyroid and major neck surgeries.…”

Section: Discussionmentioning

confidence: 99%

Comparison of king vision and truview laryngoscope for postextubation visualization of vocal cord mobility in patients undergoing thyroid and major neck surgeries: A randomized clinical trial

et al. 2017

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Background:Visualization of vocal cords following extubation after thyroid and major neck surgeries is highly desirable for the surgeon as well as the anaesthesiologist to rule out vocal cord palsy or oedema. As the patient is emerging from general anaesthesia, it may be challenging for the anaesthesiologist to optimally visualise and grade vocal cord movement following extubation.Setting:Randomized clinical trial at a tertiary care centre.Methodology:After obtaining institutional ethics committee approval, 60 patients posted for thyroid and major neck surgeries under American Society of Anesthesiologists (ASA) grade I and II were recruited for the study. Written informed consent was obtained. Pre-operatively indirect laryngoscopy was performed in all the patients to assess baseline vocal cord function. All patients were premedicated and induced and maintained as per standardized anaesthesia protocol. Patients were randomized using a sealed envelope technique to either Group K where intubation was performed using Kings vision laryngoscope or Group T where intubation was performed using True view laryngoscope. Glottis visualization was graded in all patients and intubated. Ten minutes prior to extubation injection. dexmedetomidine 1 μg/kg was administered. Once patients satisfied extubation criteria, laryngoscopy was performed using respective video-laryngoscope in each group, patient extubated under vision and assessed for vocal cord visualization and mobility grade (VMG) and patient reactivity score (PRS). Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure was also noted. Total intraoperative morphine consumption was recorded. Vocal cord function was assessed again before the day of discharge by indirect laryngoscopy.Results:Age (P = 0.27), sex (P = 0.08), body mass index (P = 0.70), ASA (P = 0.39), mallampati class (P = 0.72) and morphine used (P = 0.39) were comparable in both groups. There was no statistically significant difference among the two groups with respect to VMG (P = 0.18). There was no statistical difference in the PRS (P = 0.06) in both groups. Increase in heart rate or mean arterial pressure from baseline was not significant statistically in both groups. Time taken for laryngoscopy during extubation was significantly less with group T as compared to group K (P = 0.000).Conclusion:Both Kings Vision and Truview Video-laryngoscopes provide comparable laryngoscopic view with similar patient comfort, although clinically Truview may be a better choice due to less time consumed for visualisation and rating vocal cord movement during extubation.

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“…[1213] However, its availability, setup, and skill of the operator are major drawbacks in using fiber-optic laryngoscopy on a routine basis for all thyroid and major neck surgeries.…”

Section: Discussionmentioning

confidence: 99%

Comparison of king vision and truview laryngoscope for postextubation visualization of vocal cord mobility in patients undergoing thyroid and major neck surgeries: A randomized clinical trial

et al. 2017

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“…We should consider thyroidectomy a possible cause of extubation failure and manage it accordingly. Authors recommend following Bailey's manoeuvre13 14 by adding intubating laryngeal mask airway (LMA) or air-Q simultaneously with ETT followed by an extubation trial, or by keeping the tube exchanger inside the trachea after extubation for the meantime in these post-thyroidectomy patients, to look for bilateral vocal cord movement by flexible FOB under sedation, and then taking a decision accordingly 15. Among non-invasive methods, laryngeal ultrasound is an emerging modality that can also be utilised to assess the vocal cords 16…”

Section: Discussionmentioning

confidence: 99%

Head injury patient with bilateral vocal cord paralysis: a mistake and a lesson learnt

et al. 2015

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Bilateral recurrent nerve palsy along with head injury is a rare clinical possibility and can be potentially fatal if not properly diagnosed. We report a case of a head injury patient with intact Glasgow Coma Scale requiring immediate re-intubation and tracheostomy after extubation failure as a result of stridor and severe dyspnoea with paradoxical respiratory pattern, possibly because of undiagnosed significant surgical history.

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“…This technique has been previously described. 8,9 Evidence of tracheomalacia secondary to the thyroid goiter is largely limited to areas with endemic goiters, and it remains a rare diagnosis. A retrospective review from India by Agarwal et al identified 28 (3.1%) of 900 patients undergoing a thyroidectomy who required treatment for tracheomalacia, with 26 (2.8%) receiving a tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Management of a patient with tracheomalacia and supraglottic obstruction after thyroid surgery

Lee

Cooper

Goldstein

2011

Can J Anesth/J Can Anesth

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Purpose We describe an unusual combination of dynamic supraglottic, glottic, subglottic, and intrathoracic airway obstructions following a total thyroidectomy. These problems were anticipated, documented videographically, and managed preemptively. Clinical features Following a total thyroidectomy, we replaced the endotracheal tube with a laryngeal mask airway, namely, the LMA-Classic TM , in a patient with symptomatic tracheal compression and probable obstructive sleep apnea. Spontaneous ventilation was observed bronchoscopically through the LMA-Classic. Supraglottic swelling, extraglottic collapse on inspiration, and intrathoracic collapse on expiration were documented prior to recovery. These observations were of sufficient concern to warrant reinsertion of the endotracheal tube and subsequent tracheal extubation over a tube exchanger. Thereafter, we provided face-mask continuous positive airway pressure using a Boussignac mask with an endotracheal ventilation catheter in situ. Conclusions Acute airway collapse following thyroid surgery is a rare and potentially serious complication. Diagnosis by conventional methods may be insensitive. Difficulties may not be apparent until the patient becomes distressed after tracheal extubation, and this circumstance will worsen airway compromise. In such a state, reestablishing the airway can become life-threatening. We describe the preemptive identification, physiologic manifestations, and management of the supraglottic and subglottic obstruction exemplified by this case. RésuméObjectif Nous de´crivons une combinaison inhabituelle d'obstructions dynamiques supraglottique, glottique, sous-glottique et intrathoracique des voies ae´riennes apre`s une thyroı¨dectomie totale. Ces proble`mes ont e´te´anticipe´s, documente´s par vide´o et pris en charge de façon pre´ventive. É léments cliniques A`la suite d'une thyroı¨dectomie totale, nous avons remplace´la sonde endotrache´ale par un masque larynge´, le LMA-Classic TM , chez un patient pre´sentant une compression trache´ale symptomatique et une apne´e obstructive du sommeil probable. La ventilation spontane´e a e´te´observe´e par bronchoscopie via le LMA-Classic. Un oede`me supraglottique, un collapsus extraglottique al 'inspiration et un collapsus intrathoracique a`l'expiration ont e´te´documente´s avant le re´veil. Ces observations e´taient suffisamment pre´occupantes pour justifier la re´insertion de la sonde endotrache´ale suivie de l'extubation trache´ale sur un e´changeur de sonde. Par la suite, nous avons mis en place une ventilation a`pression positive continue avec un masque facial de Boussignac et un cathe´ter endotrache´al de ventilation in situ.Electronic supplementary material The online version of this article (doi:10.1007/s12630-011-9570-y) contains supplementary material, which is available to authorized users.

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Post‐thyroidectomy vocal cord examination by fibreoscopy aided by the laryngeal mask airway

Cited by 15 publications

References 1 publication

Comparison of king vision and truview laryngoscope for postextubation visualization of vocal cord mobility in patients undergoing thyroid and major neck surgeries: A randomized clinical trial

Comparison of king vision and truview laryngoscope for postextubation visualization of vocal cord mobility in patients undergoing thyroid and major neck surgeries: A randomized clinical trial

Head injury patient with bilateral vocal cord paralysis: a mistake and a lesson learnt

Management of a patient with tracheomalacia and supraglottic obstruction after thyroid surgery

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