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Assessment of pre-extubating recurrent laryngeal nerve palsy using ultrasound in postoperative patients with esophageal cancer: a prospective observational study

  • 0Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-city, Saitama, 350-8550, Japan. tomomi_k@saitama-med.ac.jp.
Journal of Anesthesia +

|

March 2, 2024

|

March 2, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Ultrasound can diagnose recurrent laryngeal nerve (RLN) paralysis before extubation with high accuracy, though interrater reliability is limited. This non-invasive method aids in detecting postoperative RLN paralysis.

Area Of Science

  • Anesthesiology
  • Otolaryngology
  • Medical Imaging

Background

  • Recurrent laryngeal nerve (RLN) paralysis diagnosis often relies on post-extubation assessments.
  • Ultrasound's utility for pre-extubation RLN paralysis evaluation remains underexplored.
  • Vocal cord movement assessment is crucial for identifying RLN injury post-surgery.

Purpose Of The Study

  • To assess the interrater reliability (versatility) of pre-extubation ultrasound for vocal cord movement.
  • To determine the usefulness and diagnostic accuracy of pre-extubation ultrasound for RLN paralysis.
  • To compare ultrasound findings with bronchoscopy diagnoses.

Main Methods

  • 30 patients undergoing radical esophageal cancer surgery were included.
  • Ultrasound examinations were performed by an experienced examiner before and after extubation.
  • Bronchoscopy confirmed the diagnosis; three blinded anesthetists reviewed ultrasound videos.

Main Results

  • The experienced examiner achieved 76.7% diagnostic accuracy for RLN paralysis before extubation.
  • Ultrasound demonstrated high specificity (0.95) and negative predictive value (0.87).
  • Interrater reliability (kappa coefficients) was generally low, indicating limited versatility.

Conclusions

  • Pre-extubation ultrasound by an experienced examiner shows high accuracy and specificity for diagnosing RLN paralysis.
  • The study highlights limitations in interrater reliability for this technique.
  • Ultrasound offers a promising non-invasive tool for early detection of postoperative RLN paralysis.

Keywords:

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