Topical anesthetic techniques in office‐based laryngeal surgery: A comparison of patient preferences

Abstract

Objectives: Multiple topical anesthesia techniques exist for office-based laryngeal surgery. Our objective was to assess patient and surgeon satisfaction for three different techniques.Study Design: Cohort study. Methods: All consecutive patients presenting to an outpatient laryngology office for awake surgical procedures were enrolled. Patients were anesthetized with local anesthesia (2 cubic centimeters of 4% lidocaine) in one of three ways: 1) nebulizer, 2) flexible cannula through a channeled laryngoscope, or 3) transtracheal instillation. Demographics, procedure times, and surgeon satisfaction were recorded. A validated 11-item patient satisfaction questionnaire (Iowa Satisfaction with Anesthesia Survey) was administered after the procedure to calculate an overall satisfaction score (−3[worst] to 3[best]). Descriptive and correlative statistics were performed.Results: One hundred consecutive patients were included (37 females, 73 males), with relatively equal numbers between groups (32 nebulizer, 35 cannula, 33 transtracheal). Seven procedures were aborted (4 nebulizer, 2 cannula, 1 transtracheal) due to movement, anxiety, or technical issues. Three patients did not adequately complete the survey. Of the 90 remaining patients, patient satisfaction was highest with the transtracheal technique (2.04) versus cannula (1.46) or nebulizer (1.45), and this was statistically significant (P = 0.0167). This difference was driven by decreased pain and nausea scores in the transtracheal group. Surgeon satisfaction was lower with nebulizer and higher with transtracheal injection (P = 0.0081). There was a correlation between surgeon satisfaction and patient satisfaction (P < 0.0001).Conclusion: Transtracheal instillation was favored by both patients and the surgeon. Choice of local anesthetic techniques may impact patient preferences and surgical success. This may serve as a basis for optimizing anesthetic care in office-based laryngeal surgery.

Superior Laryngeal Nerve Block for Microlaryngoscopic Surgery: A Systematic Review and Meta‐Analysis

“…[12][13][14] Therefore, adequate anesthesia is required to inhibit the stress response during MLS. [15][16][17][18] Furthermore, the laryngeal muscles are more resistant to neuromuscular blocking agents than the peripheral muscles, and deep neuromuscular block (NMB) seems to be the optimal NMB regimen for MLS. 19,20 Therefore, most MLS is performed under general anesthesia with endotracheal intubation by moderate or deep NMB.…”

“…In addition, significant strong stimulation could increase postoperative complications, such as postoperative sore throat (POST), cough, laryngeal edema, and hoarseness 12–14 . Therefore, adequate anesthesia is required to inhibit the stress response during MLS 15–18 …”