AANA October 2021 Journal Course: Vocal Cord Paralysis: Implications for Anesthesia Care-Article

Article

Pdf Summary

Vocal cord paralysis (VCP) can be neurogenic or mechanical in origin and is characterized by the absence of movement in one or both vocal cords. It can result from surgical injury, intubation, malignancy, neurologic diseases, or trauma. VCP, whether temporary or permanent, increases the risk of respiratory distress and aspiration in the perioperative period. Patients with unilateral VCP typically experience voice changes and respiratory symptoms, while those with bilateral VCP may face airway obstruction. Intubation-related laryngeal injuries are common and can be temporary or permanent, with contributing factors including tube size, cuff location, and inflation pressure. Care of patients with preexisting VCP involves maintaining mobile vocal cord function and preventing laryngeal edema, while care after vocal cord medialization procedures focuses on airway size maintenance and minimizing edema. In patients with bilateral VCP, persistent airway compromise may require tracheostomy. In general, measures such as smaller endotracheal tubes, atraumatic intubation, perioperative corticosteroids, and smooth emergence and extubation can help prevent complications in patients with VCP. Awareness of the causes, symptoms, and management strategies for VCP is essential for anesthesia providers in order to optimize care for these patients in the perioperative setting.

Keywords

Vocal cord paralysis

neurogenic

mechanical

surgical injury

intubation

respiratory distress

voice changes

airway obstruction

laryngeal injuries

perioperative period