Glottic and Neoglottic Insufficiency: Causes, Functional Problems and Evaluation

Alicandri‐Ciufelli, Matteo; Mattioli, Francesco; Tassi, Sauro; Valerini, Sara

doi:10.1007/978-3-319-20143-6_3

Cited by 1 publication

(2 citation statements)

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“… 4 – 6 Glottic incompetence secondary to VCP impairs swallowing, which can delay oral feeding and bowel movement recovery. 7 – 9 Although not life-threatening, iatrogenic dysphonia greatly affects the patient's quality of life and is susceptible to litigation where the anaesthesiologist is often named as the defendant. 10 …”

Section: Discussionmentioning

confidence: 99%

“…Recurrent laryngeal nerve (RLN) and laryngeal injuries are probably involved and several patient and surgical-related risk factors have been proposed. 4 – 7 Although the relationships among such risk factors and the incidence of VCP are clear, their effects on the severity of VCP with regards to airway obstruction and recovery have not been fully examined. Furthermore, the incidence and severity of VCP in high-risk patients undergoing implantable ventricular assist device (VAD) surgery or new, less invasive procedures including endovascular debranching repair are unknown.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Taenaka

Shibata²,

Okitsu³

et al. 2017

European Journal of Anaesthesiology

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BACKGROUNDVocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur.OBJECTIVETo evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors.DESIGNSingle-centre retrospective review of adult patients.SETTINGOsaka University Hospital, Suita, Japan, from January 2013 to August 2015.PATIENTSWe included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases.MAIN OUTCOME MEASURESThe incidence and severity of VCP after extubation.RESULTSThe incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P < 0.001) and ventricular assist device implantation (OR 3.460, P = 0.005) were independent predictors for VCP.CONCLUSIONThe identification of these risk factors may facilitate screening for VCP before extubation and possibly help anaesthesia personnel to be prepared to treat VCP-related airway obstruction should it occur.

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