Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-city, Saitama, 350-8550, Japan.
Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan.
J Anesth. 2024 Jun;38(3):347-353. doi: 10.1007/s00540-024-03315-7. Epub 2024 Mar 2.
Ultrasound performed after extubation has been suggested to be useful for the diagnosis of recurrent laryngeal nerve (RLN) paralysis. However, the use of ultrasound for this purpose before extubation has not been examined. The aim of this study was to examine the versatility (interrater reliability) and usefulness of ultrasound for evaluating the movement of vocal cords before extubation.
The subjects were 30 patients who underwent radical surgery for esophageal cancer from August 2020 to December 2021. An experienced examiner performed an ultrasound examination before and after elective extubation on the day after surgery to evaluate RLN paralysis and record videos. Bronchoscopy was then performed to make a definite diagnosis. Three anesthetists blinded to the diagnosis also evaluated the cases using the videos, and the versatility of the examination was determined using a kappa test.
The diagnostic accuracies of the examiner and three anesthetists were 76.7%, 50.0%, 53.3%, and 46.7%, respectively, and the kappa coefficients for the examiner with the anesthetists were 0.310, 0.502, and 0.169, respectively. The sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of RLN paralysis by the examiner using ultrasound before extubation were 0.57, 0.95, 0.80, and 0.87, respectively.
These results indicate a lack of versatility of the ultrasound examination based on the low kappa coefficients. However, with an experienced examiner, ultrasound can serve as a non-invasive examination that can be performed before extubation with high accuracy and specificity for diagnosis of postoperative RLN paralysis.
有研究表明，拔管后进行超声检查有助于诊断喉返神经（RLN）麻痹。然而，尚未有研究检查拔管前使用超声的效果。本研究旨在检验超声在拔管前评估声带运动的适用性（组内信度）和实用性。
本研究纳入了 2020 年 8 月至 2021 年 12 月间因食管癌接受根治性手术的 30 例患者。一位经验丰富的检查者在术后第 2 天择期拔管前后进行超声检查，以评估 RLN 麻痹并记录视频。然后进行支气管镜检查以明确诊断。3 位麻醉师在不知道诊断结果的情况下使用视频进行评估，使用 Kappa 检验评估检查的适用性。
检查者和 3 位麻醉师的诊断准确率分别为 76.7%、50.0%、53.3%和 46.7%，检查者与麻醉师的 Kappa 系数分别为 0.310、0.502 和 0.169。拔管前超声检查诊断 RLN 麻痹的敏感度、特异度、阳性预测值和阴性预测值分别为 0.57、0.95、0.80 和 0.87。
这些结果表明，基于较低的 Kappa 系数，超声检查的适用性较差。然而，在有经验的检查者的操作下，超声可以作为一种非侵入性的检查手段，在拔管前进行，具有较高的准确性和特异性，可用于诊断术后 RLN 麻痹。
