Vocal impairment after thyroidectomy is an area of particular concern because of the operative risks of vocal cord palsy secondary to recurrent laryngeal nerve (RLN) injury. Thus, it would seem reasonable to assume that thyroidectomy is likely to be at increased risk of ETT-related laryngeal trauma than operations outside the head and neck region where there is no movement of the larynx. 6 Patients undergoing thyroidectomy may be at particularly increased risk of postoperative laryngeal morbidity compared with other operations because of the strong attachments of the thyroid gland to the trachea, such that intraoperative mobilization of the thyroid leads to an inevitable degree of movement of the trachea and larynx against the fixed ETT, with consequent risk of trauma to tracheal mucosa, vocal cords, and arytenoids. 1, 3 - 5ĭespite a low incidence of major complications, thyroid surgery may be associated with postoperative laryngeal symptoms, including vocal changes in the absence of impaired vocal cord mobility, and sore throat. This shift has been driven by a perceived impression of reduced laryngeal morbidity, better preservation of voice quality, and decreased incidence of sore throat with smaller-diameter ETTs, although strong objective evidence to support this impression is somewhat limited. 1 In 1930, Magill recommended the use of the “largest endotracheal tube which the larynx can comfortably accommodate.” 2 (p 819) More recently, there has been a gathering momentum toward selecting ETTs of decreasing diameter. The optimum size of endotracheal tube (ETT) for general anesthesia remains a matter of debate.
USING XLSTAT AFTER TRIAL PERIOD REGISTRATION
Trial Registration Identifier: NCT02136459 However, because of the small sample size, our study may have been underpowered to detect small differences. At 3 weeks, no significant differences were found in changes in the 30-item Voice Handicap Index score (−2.2 vs −1.3, P = .74), GRBAS scores, or laryngoscopic score (0.25 vs 0.16, P = .67).Ĭonclusions and Relevance We did not find evidence that smaller ETT size for thyroidectomy has any significant effect on postoperative vocal outcomes, incidence of laryngeal trauma as assessed by laryngoscopy, or pain scores. Results At 24 hours, no significant differences were found between patients in groups 1 and 2 in change in GRBAS scores, change in laryngoscopic score (1.71 vs 1.76, P = .90), or postoperative pain score (3.3 vs 3.2, P = .91). Main Outcomes and Measures Fiberoptic videolaryngoscopy with modified scoring system, voice assessment using the GRBAS (grade, roughness, breathiness, asthenia, strain) rating scale, vocal self-assessment using the 30-item Voice Handicap Index, and subjective pain score. Patients were assessed preoperatively and at 24 hours and 3 weeks postoperatively. Interventions Patients were randomized to group 1 (standard-size ETT, 8.0 mm for men and 7.5 mm for women n = 24) or group 2 (small ETT, 7.0 mm for men and 6.5 mm for women n = 25). Objective To test our hypothesis that intubation with a smaller ETT would lead to reduced postoperative vocal impairment and associated reduced laryngoscopic evidence of laryngeal trauma compared with intubation with a standard-size ETT.ĭesign, Setting, and Participants This double-blind randomized clinical trial studied patients 18 years and older undergoing elective thyroidectomy at an academic teaching hospital from October 15, 2012, through June 13, 2013. Choice of ETT size may be of particular relevance to thyroid surgery because of the increased risk of laryngeal trauma and concerns regarding postoperative vocal outcomes. Importance The optimum size of endotracheal tube (ETT) for general anesthesia remains unresolved. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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