Subglottic high frequency jet ventilation in surgical management of bilateral vocal fold paralysis after thyroidectomy

Abstract

Lesion of the recurrent laryngeal nerves as a consequence of thyroid surgery results in bilateral vocal fold paralysis and respiratory obstruction. Te initial treatment involves ensuring an adequate airway and it ranges from tracheostomy to endo-extralaryngeal laterofxating operations in general anesthesia. Subglottic high frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery. HFJV ofers optimal endolaryngeal working conditions, im¬mobility of vocal cords, adequate oxygenation and ventilation. Te HFJV was prospectively studied in 20 consecutive female patients with bilateral vocal fold paralysis. Ventilation was performed as subglottic HFJV via jet catheter inserted through the vocal cord. Anesthesia was administered as total intravenous anesthesia. At the end of the procedure, the jet catheter was exchanged with LMA laryngeal mask until spontaneous breathing was established. Subglottic HFJV was used in 20 pati¬ents undergoing endo-extralaryngeal laterofxating operations with suspension microlaryngoscopy. Te mean duration of surgery was 32.25 minutes, mean age 47.35 (SD 9.75) years, and mean body mass index 26.39 kg m-2(SD 5.03). Te mean arterial PaCO25 min before surgical procedure was 5.39 (SD 0.86) kPa, at 5 min of starting jet ventilation 6.19 (SD 0.91) kPa, and at the end of surgical procedure 5.93 (SD 0.99) kPa. Tere was signifcant correlation between PaCO2obtained 5 min be¬fore starting jet ventilation and PaCO2at 5 min of starting jet ventilation (p<0.05). No complications secondary to the ventilation technique were observed. No perioperative tracheotomy was necessary. It is concluded that subglottic HFJV is an easy and safe way to ventilate patients with bilateral vocal fold paralysis when endoscopic intervention is performed.