Thyroplasty under total intravenous anaesthesia with intermittent positive pressure ventilation.
OBJECTIVE
Medialization thyroplasty is a surgical technique for improving voice quality, cough effort and laryngeal competence in patients with unilateral vocal fold paralysis. Precision surgery is enabled by operating under total intravenous anaesthesia with controlled ventilation and by using a laryngoscopic video-assisted technique. The anaesthetic challenge is to manage the shared airway with the surgeon, provide a stable operative field and ensure patient safety throughout the procedure. The objective of this case series was to evaluate the use of a modified general anaesthetic technique using the laryngeal mask airway, total intravenous anaesthesia with controlled ventilation.


RESULTS
In all, 29 patients underwent medialization thyroplasty using a disposable laryngeal mask airway, total intravenous anaesthesia and controlled ventilation. Standard anaesthetic monitoring including capnography was used intraoperatively. Total intravenous anaesthesia was achieved using effect site target-controlled infusions of propofol and remifentanil.


CONCLUSIONS
The technique proved safe with stable haemodynamic observations and only two minor complications. It also provided the surgeon with stable view of the vocal folds in order to perform this precision surgery under an operating microscope.
Karmarkar
A
A
Hope Hospital, Anaesthetic Department, Salford, UK. acarrom@yahoo.co.uk
Wisely
N A
NA
Wooldridge
W
W
Jones
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D019296:Capnography; D002648:Child; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D017214:Laryngeal Masks; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010880:Piperidines / Q000627:therapeutic use; D011175:Positive-Pressure Respiration / Q000379:methods*; D015742:Propofol / Q000627:therapeutic use; D000077208:Remifentanil; D020535:Video-Assisted Surgery; D014826:Vocal Cord Paralysis / Q000601:surgery*; D014833:Voice Quality
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol