Shah Manish Kumar, Ghai Babita, Bhatia Nidhi, Verma Roshan Kumar, Panda Naresh Kumar
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Auris Nasus Larynx. 2019 Aug;46(4):593-598. doi: 10.1016/j.anl.2018.12.007. Epub 2018 Dec 19.
We evaluated the accuracy and feasibility of transcutaneous laryngeal ultrasonography as an alternative to videolaryngoscopy for assessing vocal cord mobility to rule out recurrent laryngeal nerve injury following thyroidectomy.
Forty-five adult patients scheduled to undergo elective thyroidectomy under general anesthesia were included. Preoperatively, indirect laryngoscopy and transcutaneous laryngeal ultrasonography was done for assessing vocal cord mobility. Intraoperatively, following induction, patients were intubated using videolaryngoscope. On completion of the surgical procedure, one anesthetist performed videolaryngoscopy so as to record vocal cord mobility while the patients were being extubated in deep plane of anesthesia. Simultaneously another anesthesiologist performed transcutaneous laryngeal ultrasonography.Vocal cord mobility, changes in hemodynamics and total time duration for the two procedures was recorded. Indirect laryngoscopic assessment and flexible fiberoptic laryngoscopy was done on postoperative day 1 and 7 respectively.
Postoperative videolaryngoscopy picked up bilaterally mobile vocal cords in 88.8% cases. Transcutaneous laryngeal ultrasonography could correctly identify 39(86.6%) of these patients, with 1(2.5%) patient being misdiagnosed as having bilaterally immobile vocal cords. Further, videolaryngoscopy identified 5 patients of vocal cord palsy, of which transcutaneous laryngeal ultrasonography correctly identified 3 (60%) patients. Hence, in comparison to videolaryngoscopy, the sensitivity, specificity, positive predictive value, and negative predictive value of transcutaneous laryngeal ultrasonography for assessment of vocal cords was 75%, 95.1%, 60%, and 97.5% respectively.
In patients undergoing thyroidectomy, transcutaneous laryngeal ultrasonography can serve as a non-invasive, bedside screening tool for assessing vocal cord palsy postoperatively.
我们评估了经皮喉超声检查作为视频喉镜检查的替代方法，用于评估声带活动度以排除甲状腺切除术后喉返神经损伤的准确性和可行性。
纳入45例计划在全身麻醉下接受择期甲状腺切除术的成年患者。术前进行间接喉镜检查和经皮喉超声检查以评估声带活动度。术中，诱导后使用视频喉镜对患者进行插管。手术结束时，一名麻醉医生在患者处于深麻醉平面拔管时进行视频喉镜检查以记录声带活动度。同时，另一名麻醉医生进行经皮喉超声检查。记录声带活动度、血流动力学变化以及两种检查的总时长。分别在术后第1天和第7天进行间接喉镜评估和纤维喉镜检查。
术后视频喉镜检查显示88.8%的病例双侧声带活动。经皮喉超声检查能正确识别其中39例（86.6%）患者，1例（2.5%）患者被误诊为双侧声带固定。此外，视频喉镜检查发现5例声带麻痹患者，经皮喉超声检查正确识别了其中3例（60%）。因此，与视频喉镜检查相比，经皮喉超声检查评估声带的敏感性、特异性、阳性预测值和阴性预测值分别为75%、95.1%、60%和97.5%。
对于接受甲状腺切除术的患者，经皮喉超声检查可作为一种无创的床旁筛查工具，用于术后评估声带麻痹。
