AANA Journal Course - Vocal Cord Paralysis: Implications for Anesthesia Care

Vocal cord paralysis (VCP) is the absence of movement of one or both vocal cords and can be neurogenic or mechanical in origin. Causes include surgical injury, intubation, malignancy, neurologic diseases, and trauma. Whether temporary or permanent, VCP increases the risk of respiratory distress and aspiration in the perioperative period. Changes in voice, breathing, and swallowing in acute unilateral VCP are usually evident within 24 hours after injury. Symptoms of acute bilateral VCP range from mild stridor with exertion to acute airway obstruction. Most intubation-related laryngeal injuries result from prolonged pressure on sensitive airway tissues during short- or long-term intubations. Intubation-related VCP can be temporary, resolving within 6 months, or can be permanent. Contributing factors include endotracheal tube lumen size, cuff location, and cuff inflation pressure. Considerations in care of patients with unilateral VCP include maintaining function of the mobile vocal cord and preventing laryngeal edema. Patients with bilateral VCP have a fixed glottic size, which makes preventing airway edema critical as it may precipitate respiratory distress requiring intubation or tracheostomy. Considerations in care of patients with bilateral VCP include avoiding intubation, use of smaller endotracheal tubes when necessary, atraumatic intubation, perioperative corticosteroid administration, smooth emergence, and enhanced postoperative monitoring.