Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique

Area of Science:

• Otolaryngology
• Anesthesiology
• Surgical Innovation

Background:

• Thyroplasty with arytenoid adduction (TP-AA) is a surgical procedure to correct vocal fold paralysis.
• Traditional TP-AA is performed under sedation/analgesia (SA), which can limit surgical manipulation due to patient tolerance.
• Optimizing anesthetic techniques can improve surgical efficiency and patient outcomes.

Purpose of the Study:

• To evaluate a novel sequential anesthetic technique for TP-AA.
• To determine if this technique reduces time under sedation compared to traditional SA.
• To assess the impact on total operative time and voice outcomes.

Main Methods:

• A case-control study comparing 25 TP-AA cases using a sequential general anesthesia (GA) followed by SA technique with 25 TP-AA cases under sole SA.
• The primary outcome was duration of sedation; secondary outcomes included total operative time and voice improvement via Consensus Auditory-Perceptual Evaluation of Voice.
• The sequential technique involved performing the majority of surgery under GA, transitioning to SA for voice assessment.

Main Results:

• The sequential GA-SA technique reduced sedation time by 62.3% (79.0 minutes) compared to the all-SA group (209 minutes) (P < 0.0001).
• No significant differences were observed in total operative time (209.5 vs. 200.9 minutes; P = 0.42) or voice outcome.
• The sequential technique was readily adopted by multiple anesthesia providers.

Conclusions:

• The sequential GA-SA anesthetic technique is effective for TP-AA, significantly decreasing the duration of sedation.
• This approach enables surgeons to conduct the more demanding aspects of TP-AA under GA while facilitating voice assessment under SA.
• The technique offers a viable alternative for improving surgical conditions and patient experience during TP-AA.