Frequency of transient ipsilateral vocal cord paralysis in patients undergoing carotid endarterectomy under local anesthesia

• Published in: Journal of vascular surgery 2007-07, Vol.46 (1), p.37-40
• Main Authors: Thermann, Florian, MD, Ukkat, Jörg, MD, John, Endres, MD, Dralle, Henning, MD, Brauckhoff, Michael, MD
• Format: Article
• Language: English
• Subjects: Amides - adverse effects; Anesthesia, Local - adverse effects; Anesthetics, Combined - adverse effects; Anesthetics, Local - adverse effects; Biological and medical sciences; Carotid Artery Diseases - surgery; Endarterectomy, Carotid; Female; Humans; Laryngoscopy; Male; Medical sciences; Neurology; Neurosurgery; Patient Selection; Practice Guidelines as Topic; Prilocaine - adverse effects; Prospective Studies; Remission, Spontaneous; Skull, brain, vascular surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Ultrasonography; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vocal Cord Paralysis - chemically induced; Vocal Cord Paralysis - diagnosis; Vocal Cord Paralysis - epidemiology; Vocal Cords - diagnostic imaging
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2007.02.071

Background Especially because of improvements in clinical neurologic monitoring, carotid endarterectomy done under local anesthesia has become the technique of choice in several centers. Temporary ipsilateral vocal nerve palsies due to local anesthetics have been described, however. Such complications are most important in situations where there is a pre-existing contralateral paralysis. We therefore examined the effect of local anesthesia on vocal cord function to better understand its possible consequences. Methods This prospective study included 28 patients undergoing carotid endarterectomy under local anesthesia. Vocal cord function was evaluated before, during, and after surgery (postoperative day 1) using flexible laryngoscopy. Anesthesia was performed by injecting 20 to 40 mL of a mixture of long-acting (ropivacaine) and short-acting (prilocaine) anesthetic. Results All patients had normal vocal cord function preoperatively. Twelve patients (43%) were found to have intraoperative ipsilateral vocal cord paralysis. It resolved in all cases ≤24 hours. There were no significant differences in operating time or volume or frequency of anesthetic administration in patients with temporary vocal cord paralysis compared with those without. Conclusion Local anesthesia led to temporary ipsilateral vocal cord paralysis in almost half of these patients. Because pre-existing paralysis is of a relevant frequency (up to 3%), a preoperative evaluation of vocal cord function before carotid endarterectomy under local anesthesia is recommended to avoid intraoperative bilateral paralysis. In patients with preoperative contralateral vocal cord paralysis, surgery under general anesthesia should be considered.