Abi Lutfallah Antoine, Jabbour Khalil, Gergess Afrida, Hayeck Gemma, Matar Nayla, Madi-Jebara Samia
Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano.
Saint Joseph University, School of Medicine, Hôtel-Dieu de France Hospital, Department of Anesthesia. Critical Care and Pain Management, Beirut, Líbano.
Braz J Anesthesiol. 2020 Sep-Oct;70(5):556-560. doi: 10.1016/j.bjan.2020.08.002. Epub 2020 Sep 7.
The role of type I thyroplasty (TIP) is well established as the treatment for glottal insufficiency due to vocal fold paralysis, but the ideal anesthetic management for this procedure is still largely debated. We present the case of a novel anesthetic approach for TIP using combined intermediate and superficial Cervical Plexus Block (CPB) and intermittent mild sedation analgesia.
A 51-year-old presenting with left vocal fold paralysis and obstructive sleep apnea was scheduled for TIP. An ultrasound-guided intermediate CPB was performed using the posterior approach, and 15 mL of ropivacaine 0.5% were injected in the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. Then, for the superficial CPB, a total of 10 mL 0.5% ropivacaine was injected subcutaneously, adjacently to the posterior border of the sternocleidomastoid muscle, without penetrating the investing fascia An intermittent sedation analgesia with a target-controlled infusion of remifentanyl (target 0.5 ng.mL) was used to facilitate prosthesis insertion and the fiberoptic laryngoscopy. This technique offered a safe anesthetic airway and good operating conditions for the surgeon, as well as feasible voice monitoring and optimal patient comfort.
The use of a regional technique is a promising method for the anesthetic management in TIP, especially in patients with compromised airway.
I型甲状成形术（TIP）作为治疗声带麻痹所致声门闭合不全的方法已得到充分确立，但该手术的理想麻醉管理仍存在很大争议。我们报告了一例采用颈丛阻滞（CPB）联合浅、中颈丛阻滞及间歇性轻度镇静镇痛的新型TIP麻醉方法。
一名51岁的患者因左侧声带麻痹和阻塞性睡眠呼吸暂停计划行TIP手术。采用后路超声引导下进行中颈丛阻滞，在胸锁乳突肌与椎前筋膜之间的颈后间隙注入15毫升0.5%的罗哌卡因。然后，对于浅颈丛阻滞，在胸锁乳突肌后缘附近皮下注射总共10毫升0.5%的罗哌卡因，不穿透颈深筋膜。采用瑞芬太尼靶控输注（靶浓度0.5纳克/毫升）进行间歇性镇静镇痛，以利于假体植入和纤维喉镜检查。该技术为外科医生提供了安全的麻醉气道和良好的手术条件，同时也实现了可行的语音监测和最佳的患者舒适度。
区域技术的应用是TIP麻醉管理的一种有前景的方法，尤其是对于气道受损的患者。
