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Vagal Reflex in Suspension Laryngoscopy: Identifying Associated Predictors and a Proactive Management Algorithm
Wei Li Kong1, Qing Li Yu1, Xing Tao Jing1
1Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
Journal of Voice : Official Journal of the Voice Foundation
|March 20, 2026
Summary
Reduced neck dimensions like thyromental distance predict vagal reflex during laryngoscopy. A heart rate-based protocol effectively managed these events, improving patient safety.
Area of Science:
- Otolaryngology
- Anesthesiology
- Cardiology
Background:
- Vagal reflex (VR) is a recognized complication during suspension laryngoscopy.
- Identifying predictors and effective management strategies for VR is crucial for patient safety.
Purpose of the Study:
- To identify anatomical predictors of vagal reflex (VR) during suspension laryngoscopy.
- To evaluate the efficacy of a standardized, heart rate-based stepwise management protocol for VR.
Main Methods:
- Prospective cohort study of 371 patients undergoing suspension laryngoscopy.
- Preoperative measurement of neck anatomical parameters: thyromental distance (TMD), sternomental distance (SMD), and thyromental angle (TMA).
- Correlation analysis between anatomical parameters and VR occurrence; VR managed via a stepwise protocol based on heart rate.
Main Results:
- Vagal reflex (VR) occurred in 31.8% of patients.
- Reduced TMD, SMD, and TMA were significant predictors of VR (P < 0.05).
- Stepwise protocol, including atropine and advanced life support for cardiac arrest, was 100% effective in managing VR.
Conclusions:
- Anatomical parameters (TMD, SMD, TMA) are significant predictors of VR during suspension laryngoscopy.
- A real-time heart rate-based stepwise management protocol is safe and effective for perioperative risk management.
- This protocol provides a critical framework for managing vagal reflex during laryngoscopy.
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