Laryngeal Morbidity and Quality of Tracheal Intubation

Abstract

Background: Vocal cord sequelae and postoperative hoarse- ness during general anesthesia are a significant source of mor- bidity for patients and a source of liability for anesthesiologists. Several risk factors leading to laryngeal injury have been iden- tified in the past. However, whether the quality of tracheal intubation affects their incidence or severity is still unclear. Methods: Eighty patients were randomized in two groups (n ? 40 for each) to receive a propofol–fentanyl induction regimen with or without atracurium. Intubation conditions were evaluated with the Copenhagen Score; postoperative hoarseness was assessed at 24, 48, and 72 h by a standardized interview; and vocal cords were examined by stroboscopy be- fore and 24 and 72 h after surgery. If postoperative hoarseness or vocal cord sequelae persisted, follow-up examination was performed until complete restitution. Results: Without atracurium, postoperative hoarseness oc- curred more often (16 vs. 6 patients; P ? 0.02). The number of days with postoperative hoarseness was higher when atra- curium was omitted (25 vs. 6 patients; P < 0.001). Similar findings were observed for vocal cord sequelae (incidence of vocal cord sequelae: 15 vs. 3 patients, respectively, P ? 0.002; days with vocal cord sequelae: 50 vs. 5 patients, respectively, P<0.001). Excellent intubating conditions were less frequently associated with postoperative hoarseness compared to good or poor conditions (11, 29, and 57% of patients, respectively; ex- cellent vs. poor: P ? 0.008). Similar findings were observed for vocal cord sequelae (11, 22, and 50% of patients, respectively; excellent vs. poor: P ? 0.02). Conclusions: The quality of tracheal intubation contributes to laryngeal morbidity, and excellent conditions are less fre- quently associated with postoperative hoarseness and vocal cord sequelae. Adding atracurium to a propofol–fentanyl induc- tion regimen significantly improved the quality of tracheal in