Channeled fiberoptic for vocal cord polyp excision under spontaneous respiration using intravenous anesthesia and hi-flow nasal oxygen (STRIVE-Hi) technique: A case report and review of the literature

Abstract

Microlaryngoscopy for benign vocal cord lesion excision is a procedure with good outcomes and relatively few complications that is performed worldwide. The anterior one-third of the vocal cords is a relatively common site to find benign polyps, and the excision of cases with adequate laryngeal exposure is relatively easy. However, they can sometimes present a challenge when laryngeal exposure is suboptimal, which leads to trouble in accessing the site. The factors that can lead to difficulties in laryngeal exposure are numerous, such as restricted mouth opening, limited neck extension, large tongue size, and others. The preoperative prediction of difficult laryngeal exposure (DLE) can be obtained by different scoring and grading systems. We have used the Laryngoscore in this case. However, management options for such cases remain limited. Here, we present a case that was managed using channeled cup forceps under fiberoptic endoscopy with the STRIVE-Hi technique used to administer anesthesia.

The Efficacy of Ultrasound-Guided Superior Laryngeal Nerve Block as an Adjuvant to General Anesthesia during Suspension Laryngoscopy Vocal Cord Polypectomy

“…e challenge is the relatively short operating time that demands patient quick awaking and recovery of muscle power [2]. However, the paradox is that the larynx is a highly reflexogenic region, the stimulation of the pharynx gives rise to sympathetic excitation and the consequence is that the events such as tachycardia, hypertension, and arrhythmias may happen; which means that deep anesthesia is required to suppress stress response [6].…”

“…Vocal cord polyps are benign proliferative lesions, which are usually located unilaterally at the free edge of the vocal cord membrane [ 1 ]. The main cause of polyp formation is excessive vocalization and mechanical damage resulting from misuse or intense cough [ 2 ]. Chronic/recurrent upper respiratory tract infections, smoking, allergies, and extraesophageal reflux are cofactors.…”

“…To avoid the movement of cords, coughing, or bucking, the procedure is performed under general anesthesia, in which the adequate muscle relaxation and immobile vocal cords could meet the surgical requirement [ 5 ]. The challenge is the relatively short operating time that demands patient quick awaking and recovery of muscle power [ 2 ]. However, the paradox is that the larynx is a highly reflexogenic region, the stimulation of the pharynx gives rise to sympathetic excitation and the consequence is that the events such as tachycardia, hypertension, and arrhythmias may happen; which means that deep anesthesia is required to suppress stress response [ 6 ].…”