Kundra Pankaj, Kumar Vinoth, Srinivasan Krishnamachari, Gopalakrishnan Surianarayanan, Krishnappa Sudeep
Department of Anaesthesiology and Critical Care Surgery ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India.
ANZ J Surg. 2010 Nov;80(11):817-21. doi: 10.1111/j.1445-2197.2010.05441.x. Epub 2010 Aug 19.
Assessment of vocal cord mobility using Macintosh laryngoscope is frequently performed after extubation following thyroid surgery to rule out laryngeal nerve palsy. This study compared patient comfort and assessment accuracy of post-operative vocal fold mobility with Macintosh laryngoscope and fibreoptic endoscope.
One hundred four physically fit patients undergoing thyroid surgery were included for the study. Tele-laryngoscopy was done to rule out pre-existing vocal cord palsy. Direct laryngoscopy (DL) was performed to each patient after extubation, followed by nasal fibreoptic endoscopy (NFE) to assess the vocal cord mobility. Tele-laryngoscopic assessment was repeated after 1 week to compare the DL and NFE findings. Patient reactivity score (PRS) and haemodynamic parameters were recorded with each technique.
Macintosh laryngoscope could pick up 4 (50% sensitivity and 88% specificity) and fibreoptic endoscope 7 (87.9% sensitivity and 98.9% specificity) out of the 8 vocal cord palsies identified by tele-laryngoscopy. Patients had significant discomfort during DL (PRS median 3) when compared with NFE and tele-laryngoscopy (PRS median 2), P<0.05. Grade 1 view of larynx in 92.1% patients during intubation worsened to grade 2 (76.3%) and grade 3 (15.8%) during extubation with DL, and a significant rise in mean arterial pressure and heart rate was observed from the baseline value till 5 min and when compared with NFE (P<0.05).
NFE provides accurate assessment of vocal fold mobility with reasonable patient comfort in the immediate post-operative period. Macintosh laryngoscope fails to give optimum visualization and predisposes the patient to significant discomfort and stress.
甲状腺手术后拔管后，常使用麦金托什喉镜评估声带活动度，以排除喉返神经麻痹。本研究比较了使用麦金托什喉镜和纤维内镜评估术后声带活动度时患者的舒适度和评估准确性。
104例身体健康、接受甲状腺手术的患者纳入本研究。进行远程喉镜检查以排除术前存在的声带麻痹。拔管后对每位患者进行直接喉镜检查（DL），随后进行鼻纤维内镜检查（NFE）以评估声带活动度。1周后重复进行远程喉镜评估，以比较DL和NFE的检查结果。记录每种检查方法的患者反应评分（PRS）和血流动力学参数。
在远程喉镜检查发现的8例声带麻痹中，麦金托什喉镜能发现4例（敏感性50%，特异性88%），纤维内镜能发现7例（敏感性87.9%，特异性98.9%）。与NFE和远程喉镜检查（PRS中位数为2）相比，患者在DL检查期间有明显不适（PRS中位数为3），P<0.05。插管期间92.1%患者的喉部视野为1级，在拔管时使用DL检查恶化至2级（76.3%）和3级（15.8%），并且从基线值到5分钟时平均动脉压和心率显著升高，与NFE相比有统计学差异（P<0.05）。
NFE在术后即刻能为声带活动度提供准确评估，且患者舒适度尚可。麦金托什喉镜无法提供最佳视野，使患者易出现明显不适和应激反应。
