PMID- 28688211
OWN - NLM
STAT- MEDLINE
DCOM- 20171204
LR  - 20180526
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Linking)
VI  - 127
IP  - 12
DP  - 2017 Dec
TI  - Reducing sedation time for thyroplasty with arytenoid adduction with sequential 
      anesthetic technique.
PG  - 2813-2817
LID - 10.1002/lary.26743 [doi]
AB  - OBJECTIVE: To determine the extent to which a sequential anesthetic technique 1) 
      shortens time under sedation for thyroplasty with arytenoid adduction (TP-AA), 2) 
      affects the total operative time, and 3) changes the voice outcome compared to 
      TP-AA performed entirely under sedation/analgesia. STUDY DESIGN: Case-control 
      study. METHODS: A new sequential anesthetic technique of performing most of the 
      TP-AA surgery under general anesthesia (GA), followed by transition to 
      sedation/analgesia (SA) for voice assessment, was developed to achieve smooth 
      emergence from GA. Twenty-five TP-AA cases performed with the sequential GA-SA 
      technique were compared with 25 TP-AA controls performed completely under 
      sedation/analgesia. The primary outcome measure was the time under sedation. 
      Voice improvement, as assessed by Consensus Auditory-Perceptual Evaluation of 
      Voice, and total operative time were secondary outcome measures. RESULTS: With 
      the conventional all-SA anesthetic, the duration of SA was 209 +/- 26.3 minutes. 
      With the sequential GA-SA technique, the duration of SA was 79.0 +/- 18.9 minutes, 
      a 62.3% reduction (P < 0.0001). There was no significant difference in the total 
      operative time (209.5 vs. 200.9 minutes; P = 0.42) or in voice outcome. This 
      sequential anesthetic technique has been easily adopted by multiple 
      anesthesiologists and nurse anesthetists at our institution. CONCLUSION: TP-AA is 
      effectively performed under sequential GA-SA technique with a significant 
      reduction in the duration of time under sedation. This allows the surgeon to 
      perform the technically more challenging part of the surgery under GA, without 
      having to contend with variability in patient tolerance for laryngeal 
      manipulation under sedation. LEVEL OF EVIDENCE: 3b. Laryngoscope, 127:2813-2817, 
      2017.
CI  - (c) 2017 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Saadeh, Charles K
AU  - Saadeh CK
AD  - Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck 
      Surgery.
FAU - Rosero, Eric B
AU  - Rosero EB
AD  - Department of Anesthesiology and Pain Management, University of Texas 
      Southwestern Medical Center, Dallas, Texas, U.S.A.
FAU - Joshi, Girish P
AU  - Joshi GP
AD  - Department of Anesthesiology and Pain Management, University of Texas 
      Southwestern Medical Center, Dallas, Texas, U.S.A.
FAU - Ozayar, Esra
AU  - Ozayar E
AD  - Department of Anesthesiology and Pain Management, University of Texas 
      Southwestern Medical Center, Dallas, Texas, U.S.A.
FAU - Mau, Ted
AU  - Mau T
AUID- ORCID: 0000-0002-1804-6707
AD  - Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck 
      Surgery.
LA  - eng
PT  - Journal Article
DEP - 20170708
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anesthesia, General/*methods
MH  - Arytenoid Cartilage/*surgery
MH  - Case-Control Studies
MH  - Conscious Sedation/*methods
MH  - Female
MH  - Humans
MH  - Laryngoplasty/*methods
MH  - Male
MH  - Middle Aged
MH  - Time Factors
MH  - Young Adult
OTO - NOTNLM
OT  - Vocal fold paralysis
OT  - arytenoid adduction
OT  - laryngeal framework surgery
OT  - medialization laryngoplasty
OT  - moderate sedation
OT  - sedation/analgesia
OT  - thyroplasty
EDAT- 2017/07/09 06:00
MHDA- 2017/12/05 06:00
CRDT- 2017/07/09 06:00
PHST- 2017/03/26 00:00 [received]
PHST- 2017/05/22 00:00 [accepted]
PHST- 2017/07/09 06:00 [pubmed]
PHST- 2017/12/05 06:00 [medline]
PHST- 2017/07/09 06:00 [entrez]
AID - 10.1002/lary.26743 [doi]
PST - ppublish
SO  - Laryngoscope. 2017 Dec;127(12):2813-2817. doi: 10.1002/lary.26743. Epub 2017 Jul 
      8.