Vocal cord paralysis (VCP) is the absence of move¬ment of one or both vocal cords and can be neuro¬genic or mechanical in origin. Causes include surgical injury, intubation, malignancy, neurologic diseases, and trauma. Whether temporary or permanent, VCP increases the risk of respiratory distress and aspira¬tion in the perioperative period. Changes in voice, breathing, and swallowing in acute unilateral VCP are usually evident within 24 hours after injury. Symptoms of acute bilateral VCP range from mild stridor with exertion to acute airway obstruction. Most intuba¬tion-related laryngeal injuries result from prolonged pressure on sensitive airway tissues during short- or long-term intubations. Intubation-related VCP can be temporary, resolving within 6 months, or can be permanent. Contributing factors include endotracheal tube lumen size, cuff location, and cuff inflation pres¬sure. Considerations in care of patients with unilateral VCP include maintaining function of the mobile vocal cord and preventing laryngeal edema. Patients with bilateral VCP have a fixed glottic size, which makes preventing airway edema critical as it may precipitate respiratory distress requiring intubation or tracheos¬tomy. Considerations in care of patients with bilateral VCP include avoiding intubation, use of smaller endo¬tracheal tubes when necessary, atraumatic intubation, perioperative corticosteroid administration, smooth emergence, and enhanced postoperative monitoring.

Learning Outcome(s):

1. Compare normal laryngeal function with variations found in patients with unilateral and bilateral vocal cord paralysis.
2. Identify causes of unilateral and bilateral vocal cord paralysis, including surgical procedures and coexisting diseases.  
3. List factors contributing to intubation-related laryngeal injuries and recommendations to decrease likelihood of injury.    
4. Discuss considerations in care of patients with preexisting unilateral and bilateral vocal cord paralysis.   
5. Describe considerations in care of patients after vocal cord medialization procedures.    

This program has been prior approved by the American Association of Nurse Anesthesiology for 1.00 Class A CE credits; Code Number 1041207; Expiration Date 10/4/2024.

Karen J. Maresch, DNAP, CRNA

Accreditation Information:
The American Association of Nurse Anesthesiology is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. 

AANA is an approved provider by the California Board of Registered Nursing, CEP #10862.

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A minimum passing score of 80% is required to pass this course. You have TWO opportunities to achieve a passing score. If you fail to achieve a passing score of 80%, you will not receive CE credit for this course.

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