Anesthetic management of endoscopic microsurgical interventions for bilateral vocal cord paralysis
Surgical repair of bilateral vocal cord paralysis is widely considered as one of the most complicated procedures in laryngeal microsurgery. Unobstructed view of laryngeal structures and adequate amount of working space are essential prerequisites for successful microsurgical operation. In order to provide necessary surgical condition several ventilatory techniques can be employed. Available options include preventive tracheostomy, conventional ventilation via small endotracheal tubes and jet ventilation. At the same time, improvement of surgeons’ working conditions is never considered as an ultimate goal if it does not lead to better results or decrease of expenses. Materials and methods. We report a retrospective study of 104 patients who had undergone microlaryngeal surgery for bilateral vocal cord paralysis. Duration of hospital stay, duration of surgery and time spent in the operating room were compared between the three groups of patients with different ventilation strategies.Results. The highest duration of hospital stay was in the group of preventive tracheostomy (18,68±7,48 days), whereas in the groups of tracheal intubation and subglottic jet ventilation it was considerably lower (12,9±7,11 and 12,15±5,69 respectively).Conclusions. Obtained data suggest that preventive tracheostomy performed prior to endoscopic microlaryngeal surgery is the major independent risk factor of prolonged hospital stay for patients with bilateral vocal cord paralysis