Audu Paul, Artz Greg, Scheid Sarah, Harrop James, Albert Todd, Vaccaro Alexander, Hilibrand Alan, Sharan Ashwini, Spiegal Joseph, Rosen Marc
Department of Anesthesiology, Jefferson Medical College, 111 South 11th Street, Suite G-8490, Philadelphia, Pennsylvania 19107, USA.
Anesthesiology. 2006 Nov;105(5):898-901. doi: 10.1097/00000542-200611000-00009.
Vocal fold immobility (paresis or paralysis) from recurrent laryngeal nerve injury remains an important cause of morbidity after anterior cervical spine surgery. A maneuver involving endotracheal tube (ETT) cuff manipulation has been proposed to reduce its incidence. This study is a randomized, prospective, double-blind investigation to test the hypothesis that ETT cuff manipulation reduces the incidence of postoperative vocal fold immobility after anterior cervical spine surgery.
One hundred patients scheduled to undergo anterior cervical spine surgery were randomly assigned to one of two groups. After inducing general endotracheal anesthesia, patients in the intervention group had their ETT cuff pressures maintained at 20 mmHg or less. After placement of self-retaining retractors, the ETT cuff was deflated for 5 s and then reinflated. Patients in the control group had no further manipulation of their ETT once the cuff was inflated after intubation. Cuff pressures in both groups were recorded before skin incision (baseline) and after placement of self-retaining retractors (peak). Patients' vocal fold motion was evaluated by indirect laryngoscopy performed preoperatively and postoperatively. The examination was videotaped and reviewed by a blinded otolaryngologist. Postoperative vocal fold motion was graded as normal, paretic, or paralyzed.
Complete data were available in 94 patients. The incidence of vocal fold paralysis was 3.2% (95% confidence interval, 0.7-9.4%). Cuff manipulation decreased ETT cuff pressure but did not reduce the incidence of vocal fold immobility (15.4% vs. 14.5%).
Endotracheal tube cuff deflation/reinflation and pressure adjustment do not reduce the incidence of vocal fold immobility in anterior cervical spine surgery.
喉返神经损伤导致的声带运动障碍（轻瘫或麻痹）仍是颈椎前路手术后发病的重要原因。有人提出一种涉及气管内插管（ETT）套囊操作的手法来降低其发生率。本研究是一项随机、前瞻性、双盲调查，旨在检验ETT套囊操作可降低颈椎前路手术后声带运动障碍发生率这一假设。
100例计划行颈椎前路手术的患者被随机分为两组。诱导全身气管内麻醉后，干预组患者的ETT套囊压力维持在20 mmHg或更低。放置自持式牵开器后，ETT套囊放气5 s，然后重新充气。对照组患者插管后套囊充气后不再对ETT进行进一步操作。两组均在皮肤切开前（基线）和放置自持式牵开器后（峰值）记录套囊压力。术前和术后通过间接喉镜检查评估患者的声带运动。检查过程进行录像，并由一位不知情的耳鼻喉科医生进行复查。术后声带运动分为正常、轻瘫或麻痹。
94例患者获得了完整数据。声带麻痹的发生率为3.2%（95%置信区间，0.7 - 9.4%）。套囊操作降低了ETT套囊压力，但并未降低声带运动障碍的发生率（15.4%对14.5%）。
气管内插管套囊放气/重新充气及压力调整并不能降低颈椎前路手术中声带运动障碍的发生率。
