Risk factors of arytenoid dislocation after endotracheal intubation: A propensity‐matched analysis

Kong, Xiangyu; Song, Yang; Wang, Lijun; He, Guiqin; Ma, Changhong; Zhao, Rui; Wang, Minjun; Shi, Lin; Cui, Wanming

doi:10.1002/lio2.977

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Fourth, the lightwand technique is based on no visualization of the airway with a lighted stylet, which may increase the risk of mechanical vocal cord damage during intubation. Mechanical laryngeal injury, such as arytenoid dislocation or subluxation, may occur in patients who received endotracheal intubation, with a 0.01% incidence rate (22). The reported risk factors include endotracheal intubation using excessive force, loosening of the cricoarytenoid joint capsule, nasogastric tube placement, and prolonged operative time (22).…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical laryngeal injury, such as arytenoid dislocation or subluxation, may occur in patients who received endotracheal intubation, with a 0.01% incidence rate (22). The reported risk factors include endotracheal intubation using excessive force, loosening of the cricoarytenoid joint capsule, nasogastric tube placement, and prolonged operative time (22). Physicians should exercise caution during intubation in patients with these factors by considering the use of visualization intubation tools.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

HONG,

LEE,

HWANG

et al. 2023

In Vivo

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Background/Aim: A lightwand is a stylet with a light bulb at its tip that can be used to guide intubation by confirming the illumination through the anterior neck. We aimed to determine the factors affecting the illumination intensity during lightwand endotracheal intubation. Patients and Methods: We retrospectively collected data from 180 patients who underwent lightwand endotracheal intubation. We recorded illumination intensity on a 5-point scale. The patients were categorized into weak (score <3) and bright (score ≥3) groups based on the illumination intensity scale score. Results: A total of 176 patients were analyzed, of whom 125 (71.1%) were enrolled in the bright group, and 51 (29.0%) were enrolled in the weak group. Multivariable logistic regression analysis revealed that an increased body mass index (BMI) and mask ventilation grade were associated with light intensity. For mask ventilation, moderate vs. easy (p=0.010) and difficult vs. easy (p=0.008) were associated with the weak group. Receiver operating characteristic curve analysis showed that BMI ≥24.6 kg/m 2 was correlated with the weak group. Conclusion: BMI ≥24.6 kg/m 2 or mask ventilation grade above moderate indicates increased odds of weak illumination intensity in lightwand intubation. Pre-intubation examination of these factors helps increase the chances of successful intubation.Successful intubation is of great importance for airway management during general anesthesia. Although intubation techniques and tools have rapidly developed, the lightwand, which has long been used in airway management, still has benefits. Lightwand intubation is a technique in which a lightbulb stylet is introduced into the endotracheal tube and the tube tip is directed into the trachea by transillumination through the anterior neck tissue (1). The lightwand has been recommended for difficult airway management by the American Society of Anesthesiologists (ASA) (2). When mask ventilation is adequate, but intubation is unsuccessful, alternative noninvasive approaches can be attempted using a lightwand, laryngeal mask airway, or different laryngoscope blades (nonemergency pathways) (1, 2). In 2022, the ASA updated their recommendations concerning the suggested equipment for the management of difficult airways (3). In particular, they suggested non-invasive and invasive alternatives by emphasizing awareness of the passage of time and limiting the number of attempts using different devices and techniques (3). Non-invasive devices include lighted or optical stylets, videolaryngoscopes, flexible intubation scopes, and adjuncts (3). In anticipated difficult airway management, if a noninvasive approach is selected, they recommend identifying a preferred sequence of non-invasive devices (3). The lightwand is easy to carry and prepare, inexpensive, and easy for physicians to learn (4). A lightwand can be a valuable disposable intubation tool for difficult intubation (5), particularly during the COVID-19 pandemic. After the 490

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

HONG,

LEE,

HWANG

et al. 2023

In Vivo

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Risk factors for the occurrence of arytenoid dislocation after major abdominal surgery: A retrospective study

Chen,

Yu,

Cui

et al. 2024

Medicine

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The incidence of arytenoid dislocation in abdominal surgery is relatively high, the cause is unknown, and it has not received sufficient attention. To identify the risk factors of arytenoid dislocation after abdominal surgery, and to establish a clinical prediction model based on relevant clinicopathological characteristics. We retrospectively collected the clinical data of 50 patients with arytenoid dislocation (AD) and 200 patients without AD after abdominal surgery with general anesthetic tracheal intubation in our Hospital from January 2013 to December 2019. General information about the patients was collected. Univariate analysis of the factors was performed, and indicators that were statistically significant were included in multivariate logistic regression analyses to identify the relationship between clinicopathological characteristics and arytenoid dislocation. Meanwhile, a clinical prediction model was established. Multivariate logistic regression analyses showed that age, surgical methods, operative time and gastric tube were dependent predictive factors of AD after abdominal surgery. A clinical prediction model was constructed, and the AUC of the ROC curve was 0.88 (95%CI: 0.83–0.94). The calibration plot shows that the prediction curve was close to the ideal curve. Patients undergoing abdominal surgery with general anesthesia exhibit a significantly higher incidence of AD due to a combination of factors. Clinicopathological features can be used as an independent predictor of risk in patients with AD, and a clinical model has been developed that is a good predictor of AD.

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Incidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and Meta-Analysis

Alalyani,

Alhedaithy,

Alshammari

et al. 2024

Cureus

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Endotracheal intubation carries risks, including arytenoid dislocation (AD), a rare but severe complication. Due to small sample sizes, the incidence of AD varies considerably among studies. Proposed risk factors for AD include difficult intubation, prolonged intubation, certain surgeries, patient positioning, female sex, and BMI. This review aims to investigate the incidence of AD and explore the various predisposing risk factors. We retrieved relevant studies up to April 2024 from PubMed, Scopus, Web of Science, and the Cochrane Library. Using OpenMeta v5.26.14 software (Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, USA), we pooled AD incidence rates from individual studies. Other outcomes, reported in fewer studies and thus not suitable for meta-analysis, were synthesized manually. Study selection yielded 16 eligible articles. A random-effects model analysis of nine studies found a significant AD incidence rate of 0.093% (confidence interval (CI): 0.045% to 0.14%), but the results were highly heterogeneous (I 2 = 91%). Older age was associated with prolonged hoarseness, while younger age and female sex increased the risk of AD. Additionally, AD risk factors included taller stature, higher BMI, specific surgeries, esophageal instrumentation, prolonged procedure durations, head-neck movement, and inexperienced intubators. However, intubation with a stylet reduced the AD risk. AD post-endotracheal intubation is rare (incidence: 0.09%), with potential underdiagnosis in larger datasets. Many risk factors may contribute to the condition, but the small number of studies per risk factor limits the ability to draw robust conclusions. Subjective diagnoses and retrospective studies further restrict comprehensive understanding. Further research is needed to explore AD risk factors effectively.

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Risk factors of arytenoid dislocation after endotracheal intubation: A propensity‐matched analysis

Cited by 3 publications

References 29 publications

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

Risk factors for the occurrence of arytenoid dislocation after major abdominal surgery: A retrospective study

Incidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and Meta-Analysis

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