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Incidence of perioperative airway complications in patients with previous medialization thyroplasty

Authors

  • Harrison W. Lin MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
    2. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Neil Bhattacharyya MD, FACS

    Corresponding author
    1. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
    2. Division of Otolaryngology–Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.
    • Division of Otolaryngology–Head and Neck Surgery, Brigham & Women's Hospital, 45 Francis Street, Boston, MA 02115
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  • Presented at the Eastern Section Meeting of the Triological Society, Boston, Massachusetts, U.S.A., January 24–25, 2009.

  • Recipient of the William W. Montgomery Resident Research Award.

Abstract

Objectives/Hypothesis:

Determine the incidence and characterize perioperative airway complications in patients who have undergone medialization thyroplasty (MT) and subsequently undergo procedures requiring anesthesia.

Study Design:

Retrospective review of post-MT anesthesia encounters in a large academic hospital.

Methods:

A series of post-MT patients was reviewed, identifying anesthesia encounters undergoing endotracheal intubation (ETI) or laryngeal mask airway (LMA) placement. Details on the perioperative course of each encounter were extracted and examined for evidence of airway complications. The incidence of airway obstruction and need for airway intervention were determined and compared to those of control patients matched for type of procedure. Relationships between complications and perioperative management were analyzed.

Results:

A total of 74 anesthesia encounters were identified among 219 post-MT patients. Perioperative airway complications among post-MT patients arose in five procedures (6.8%; 95% CI: 1.0–12.4%). Stridor in the operating or recovery room was exhibited three times, with all episodes requiring nebulized racemic epinephrine and intravenous steroids for resolution of symptoms. One patient underwent an urgent tracheotomy for severe stridor leading to airway compromise in the recovery room. Immediately after induction with an LMA, one patient failed to maintain oxygen saturations above 90% and consequently required conversion to ETI. Among 79 matched controls without prior MT, no perioperative complications (0%) occurred (P = .027).

Conclusions:

The incidence of perioperative airway complications in post-MT patients is non-neglible and may be serious. Surgical, anesthesia, and recovery room staff should be made aware of the significantly increased risk of airway complications in post-MT patients. Laryngoscope, 2009

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