Airway Management in Patients With Vocal Cord Paralysis: A Review of Intubation Techniques, Intraoperative Challenges, and Outcomes

TL;DR

This review discusses challenges in airway management for patients with vocal cord paralysis during intubation and highlights gaps in current research.

Contribution

The paper provides a comprehensive review of intubation techniques and outcomes in vocal cord paralysis patients, identifying areas needing further research.

Findings

Video laryngoscopy does not always confirm successful intubation in vocal cord paralysis patients.

Patients with vocal cord paralysis face higher risks of airway complications and require careful post-operative planning.

There is a lack of comparative studies between direct and video laryngoscopy in this patient population.

Abstract

Vocal cord paralysis (VCP) presents with unique challenges when managing airways, particularly during endotracheal intubation. This literature review explores the effects of unilateral and bilateral VCP on intubation technique, first-pass success, extubation safety, and perioperative airway planning. While video laryngoscopy (VL) is becoming increasingly favored for its superior airway visualization, it does not always confirm successful placement in patients with VCP. Complications such as airway edema, aspiration risk, and cuff misplacements are increased in this patient population, and they may be more vulnerable to post-extubation complications, especially without the use of steroid prophylaxis or intensive post-operative planning. A comparison of direct laryngoscopy (DL) versus VL in this patient population reveals a gap in the literature, emphasizing the need for more research in airway management in patients with VCP. This review combines current practices, clinical considerations for anesthesia providers, and identifies areas for further investigation.