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Xing L, Ding Y, Zhou Y, Yu L, Gao R, Gu L. A case of arytenoid dislocation after ProSeal laryngeal mask airway insertion: A case report. Int J Surg Case Rep 2024; 124:110372. [PMID: 39353315 PMCID: PMC11471643 DOI: 10.1016/j.ijscr.2024.110372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 09/23/2024] [Accepted: 09/28/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Arytenoid dislocation, typically manifested as hoarseness and coughing when drinking, is a rare perioperative scenario, with an incidence rate of 0.009 %-0.097 % and endotracheal intubation under general anesthesia being the most common cause. However, arytenoid dislocation caused by a laryngeal mask airway (LMA) is extremely rare. CASE DESCRIPTION Herein, a 53-year-old female patient was admitted for a "right breast lump" and scheduled for "unilateral mastectomy with ipsilateral axillary sentinel lymph node biopsy" under general anesthesia. During the surgery, the patient was noted to snore mildly, and rocuronium (15 mg) was immediately administered intravenously. The snoring ceased after adjusting the position of the LMA. Postoperatively, the patient was diagnosed with arytenoid dislocation by flexible nasal endoscopy after presenting with a sore throat accompanied by hoarseness and coughing when drinking. Thereafter, the patient underwent two cricoarytenoid joint reductions with a video laryngoscope under intravenous anesthesia, along with anti-inflammatory medication and voice therapy. The voice of the patient returned to normal after 1 month. CLINICAL DISCUSSION Despite being a supraglottic airway device, the LMA can still cause arytenoid dislocation in clinical practice. Hence, anesthesiologists should analyze the potential causes and understand the diagnosis and treatment of arytenoid dislocation. Although closed reduction surgery typically requires two or three attempts, with a shorter disease duration leading to better outcomes, it can also aid in voice recovery for a longer disease course. In the presented case, the patient achieved a good prognosis after two closed reduction surgeries. CONCLUSION Anesthesiologists should be vigilant for arytenoid dislocation in patients who present with persistent hoarseness and coughing while drinking after the insertion of the LMA, necessitating prompt treatment after diagnoses to achieve the best results.
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Affiliation(s)
- Lingxi Xing
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 210009 Nanjing, China
| | - Yuyan Ding
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 210009 Nanjing, China
| | - Yihu Zhou
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 210009 Nanjing, China
| | - Lixiang Yu
- Department of Otorhinolaryngology Head and Neck, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, 210019 Nanjing, China
| | - Rong Gao
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 210009 Nanjing, China
| | - Lianbing Gu
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, 210009 Nanjing, China..
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Alalyani NS, Alhedaithy AA, Alshammari HK, AlHajress RI, Alelyani RH, Alshammari MF, Alhalafi AH, Alharbi A, Aldabal N. Incidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e67917. [PMID: 39328702 PMCID: PMC11425767 DOI: 10.7759/cureus.67917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Endotracheal intubation carries risks, including arytenoid dislocation (AD), a rare but severe complication. Due to small sample sizes, the incidence of AD varies considerably among studies. Proposed risk factors for AD include difficult intubation, prolonged intubation, certain surgeries, patient positioning, female sex, and BMI. This review aims to investigate the incidence of AD and explore the various predisposing risk factors. We retrieved relevant studies up to April 2024 from PubMed, Scopus, Web of Science, and the Cochrane Library. Using OpenMeta v5.26.14 software (Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, USA), we pooled AD incidence rates from individual studies. Other outcomes, reported in fewer studies and thus not suitable for meta-analysis, were synthesized manually. Study selection yielded 16 eligible articles. A random-effects model analysis of nine studies found a significant AD incidence rate of 0.093% (confidence interval (CI): 0.045% to 0.14%), but the results were highly heterogeneous (I2 = 91%). Older age was associated with prolonged hoarseness, while younger age and female sex increased the risk of AD. Additionally, AD risk factors included taller stature, higher BMI, specific surgeries, esophageal instrumentation, prolonged procedure durations, head-neck movement, and inexperienced intubators. However, intubation with a stylet reduced the AD risk. AD post-endotracheal intubation is rare (incidence: 0.09%), with potential underdiagnosis in larger datasets. Many risk factors may contribute to the condition, but the small number of studies per risk factor limits the ability to draw robust conclusions. Subjective diagnoses and retrospective studies further restrict comprehensive understanding. Further research is needed to explore AD risk factors effectively.
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Affiliation(s)
- Nasser Saad Alalyani
- Department of Otolaryngology, Head and Neck Surgery, King Fahd Military Medical Complex, Dhahran, SAU
| | | | - Hind Khaled Alshammari
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins Aramco Healthcare, Dhahran, SAU
| | - Rafeef I AlHajress
- Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, Riyadh, SAU
| | - Rakan H Alelyani
- College of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Abdullah Hassan Alhalafi
- Department of Family and Community Medicine, College of Medicine, University of Bisha, Bisha, SAU
| | - Amani Alharbi
- Department of Otolaryngology, Head and Neck Surgery, King Fahd Military Medical Complex, Dhahran, SAU
| | - Nada Aldabal
- Department of Otolaryngology, Head and Neck Surgery, King Fahd Military Medical Complex, Dhahran, SAU
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Xu X, Yang S, Zhuang P. [Analysis of vocal fold movement characteristics in patients with laryngeal neurogenic injury]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2024; 38:426-431. [PMID: 38686482 PMCID: PMC11387309 DOI: 10.13201/j.issn.2096-7993.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Indexed: 05/02/2024]
Abstract
Objective:To analyze the characteristics of vocal fold movement and glottic closure in patients with laryngeal neurogenic injury. Methods:A total of 185 patients with vocal fold paralysis diagnosed by laryngeal electromyography as neurogenic damage to cricothyroid muscle, thyreoarytenoid muscle and posterior cricoarytenoid muscle were enrolled, they were divided into unilateral vocal fold paralysis group and bilateral vocal fold paralysis group, respectively, and superior laryngeal paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group according to nerve injury. The characteristics of vocal fold movement and glottic closure were analyzed under strobe laryngoscope. The qualitative evaluation of vocal fold movement was fixed vocal fold, reduced vocal fold movement and normal vocal fold movement, and the qualitative evaluation of glottic closure was glottic closure and glottic imperfection. The results were analyzed statistically. Results:The proportion of normal, reduced and fixed vocal fold motion in bilateral vocal fold paralysis group was significantly different from that in unilateral vocal fold paralysis group(P<0.05), the composition of normal and reduced vocal fold motion in bilateral vocal fold paralysis group(47.70%) was significantly greater than that in unilateral vocal fold paralysis group(12.27%). There was no significant difference between the proportion of glottic closure and glottic imperfecta in bilateral vocal fold paralysis group and unilateral vocal fold paralysis group(P<0.05). The proportion of decreased vocal fold motion in superior laryngeal nerve paralysis group(50.00%) was higher than that in recurrent laryngeal nerve paralysis group(9.32%) and vagal nerve paralysis group(9.00%). The proportion of decreased and fixed vocal fold motion in superior laryngeal nerve paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group was statistically significant(P<0.05).There was no significant difference in glottic closure among the three groups(P<0.05). Conclusion:Vocal fold movement characteristics of patients with laryngeal neurogenic injury were mainly vocal fold fixation, or normal or weakened vocal fold movement. There may be missed diagnosis of unilateral vocal fold paralysis in clinical practice. In half of the patients with superior laryngeal nerve palsy, vocal fold movement is characterized by vocal fold fixation.
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Affiliation(s)
- Xinlin Xu
- Department of Voice,Zhongshan Hospital of Xiamen University,Department of Otolaryngology in School of Medicine,Xiamen University,Xiamen,361004,China
| | - Sujuan Yang
- Department of Otolaryngology,Shengzhen Traditional Chinese Medical Hospital
| | - Peiyun Zhuang
- Department of Voice,Zhongshan Hospital of Xiamen University,Department of Otolaryngology in School of Medicine,Xiamen University,Xiamen,361004,China
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Yan W, Dong W, Chen Z. Prolonged Tracheal Intubation in the ICU as a Possible Risk Factor for Arytenoid Dislocation After Liver Transplant Surgery: A Retrospective Case-Control Study. Ann Transplant 2023; 28:e940727. [PMID: 37814440 PMCID: PMC10578641 DOI: 10.12659/aot.940727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Arytenoid dislocation (AD) is a rare complication of general anesthesia with tracheal intubation, with a published incidence of 0.009-0.097%. This retrospective case-control study aimed to identify risk factors associated with AD in patients who underwent liver transplantation. MATERIAL AND METHODS This study included 476 patients who underwent liver transplantation between January 2013 and December 2022. Patients with AD who underwent surgery were included in the AD group. For each case of AD, 4 patients matched by anesthesia type and anesthetist were randomly selected as the non-AD group. Data on patient characteristics, anesthetic factors, and surgical factors were collected and compared between patients with and without AD. Logistic regression analysis was performed to determine the risk factors for AD after liver transplantation. RESULTS Of the 476 patients who underwent liver transplantation, 17 (3.57%) had AD. AD occurred on the left side in 13 patients and on the right side in 4 patients. The 17 patients who experienced AD and 68 matched non-AD patients were enrolled. Patients in the AD group had a greater intubation depth (24 [23-24] vs 24 [24-24], P=0.043), a higher level of hemoglobin (134.5 [118-147.5] vs 112 [96.25-125], P=0.014), and prolonged tracheal intubation in the ICU (19.75 [15.87-31.87] vs 13 [10.62-15], P<0.001) compared to those in the non-dislocation group. Multivariate logistic regression analysis showed that prolonged tracheal intubation in the ICU was independently associated with the occurrence of AD in patients who underwent liver transplantation (P=0.013). CONCLUSIONS This study showed that the incidence of AD was 3.57% in patients undergoing liver transplant surgery and that prolonged tracheal intubation in the ICU was a possible risk factor for AD.
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Affiliation(s)
- Wenqing Yan
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, PR China
- Department of Emergency, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, PR China
| | - Weihua Dong
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, PR China
- Department of Emergency, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, PR China
| | - Zhi Chen
- Department of Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, PR China
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Jiang T, Fang B, Yu Z, Cao D. Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery. J Plast Reconstr Aesthet Surg 2023; 84:432-438. [PMID: 37413735 DOI: 10.1016/j.bjps.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment. METHODS We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared. RESULTS 441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P = 0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P = 0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy. CONCLUSION Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.
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Affiliation(s)
- Taoran Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China
| | - Bin Fang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China
| | - Zheyuan Yu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China.
| | - Dejun Cao
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Zhizaoju Road 639, Shanghai 200011, PR China.
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Yan W, Chen Z, Dong W, Qian Y. High prevalence of postoperative arytenoid dislocation in patients undergoing liver transplantation: A case-control study. Medicine (Baltimore) 2023; 102:e34771. [PMID: 37653787 PMCID: PMC10470738 DOI: 10.1097/md.0000000000034771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Arytenoid dislocation (AD) is a rare complication of surgery under general anesthesia. The potential factors for AD remain poorly defined, and the identification of risk factors is beneficial for reducing its incidence. We found that patients undergoing liver transplantation appeared to be more susceptible to postoperative AD at our hospital. The present study was designed to clarify this issue. A retrospective hospital-based case-control study was conducted in patients undergoing surgery under general anesthesia between 2017 and 2021. Recorded data for all patients were age, sex, body weight, height, body mass index, position of patients during surgery, duration of surgery, emergency status of surgery, and liver transplantation. Logistic regression analysis was performed to determine risk factors for AD. Thirty thousand one hundred fifty-four patients who underwent general anesthesia between 2017 and 2021 were included. Sixteen (0.05%) patients were diagnosed with AD, including 10 (3.9%) patients among 259 patients who underwent liver transplantation and 6 patients had complications among the 29,895 patients who underwent other operations (P < .0001). Postoperative AD incidence was significantly elevated in patients undergoing liver transplantation. This finding should be clinically relevant and alarming for anesthesiologists and clinicians to help avoid arytenoid dislocation and improve patient outcomes. Further studies that incorporate detailed data are needed to determine risk factors for AD.
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Affiliation(s)
- Wenqing Yan
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Weihua Dong
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Yihong Qian
- Department of Anesthesiology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, China
- The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Yan WQ, Li C, Chen Z. Delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the intensive care unit: A case report. World J Clin Cases 2022; 10:5119-5123. [PMID: 35801012 PMCID: PMC9198865 DOI: 10.12998/wjcc.v10.i15.5119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/05/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma. The most common symptom is persistent hoarseness. Although cases of arytenoid dislocation due to tracheal intubation are reported more frequently in otolaryngology, reports on its occurrence in the intensive care unit (ICU) are lacking. We report a case of delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the ICU.
CASE SUMMARY A 20-year-old woman was referred to the ICU following a fall from a height. Her voice was normal; laryngeal computed tomography showed unremarkable findings on admission. However, due to deterioration of the patient’s condition, tracheal intubation, and emergency exploratory laparotomy followed by laparoscopic surgery two d later under general anesthesia were performed. After extubation, the patient was sedated and could not communicate effectively. On the 10th day after extubation, the patient complained of hoarseness and coughing with liquids, which was attributed to laryngeal edema and is common after tracheal intubation. Therefore, specific treatment was not administered. However, the patient’s symptoms did not improve. Five d later, an electronic laryngoscope examination revealed dislocation of the left arytenoid cartilage. The patient underwent arytenoid closed reduction under general anesthesia by an experienced otolaryngologist. Reported symptoms improved subsequently. The six-month follow up revealed that the hoarseness had resolved within four weeks of the reduction procedure.
CONCLUSION Symptoms of arytenoid cartilage dislocation are difficult to identify in the ICU leading to missed or delayed diagnosis among patients.
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Affiliation(s)
- Weng-Qing Yan
- Medical Department of Graduate School, Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang 330006, Jiangxi Province, China
| | - Chen Li
- Department of Traumatology, Jiangxi Provincial People’s Hospital, Nanchang 330006, Jiangxi Province, China
| | - Zhi Chen
- Department of Emergency, Jiangxi Provincial People’s Hospital, Nanchang 330006, Jiangxi Province, China
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Jang EA, Yoo KY, Lee S, Song SW, Jung E, Kim J, Bae HB. Head-neck movement may predispose to the development of arytenoid dislocation in the intubated patient: a 5-year retrospective single-center study. BMC Anesthesiol 2021; 21:198. [PMID: 34330223 PMCID: PMC8325301 DOI: 10.1186/s12871-021-01419-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Arytenoid dislocation is a rare laryngeal injury that may follow endotracheal intubation. We aimed to determine the incidence and risk factors for arytenoid dislocation after surgery under general anaesthesia. Methods We reviewed the medical records of patients who underwent operation under general anaesthesia with endotracheal intubation from January 2014 to December 2018. Patients were divided into the non-dislocation and dislocation groups depending on the presence or absence of arytenoid dislocation. Patient, anaesthetic, and surgical factors associated with arytenoid dislocation were determined using Poisson regression analysis. Results Among the 25,538 patients enrolled, 33 (0.13%) had arytenoid dislocation, with higher incidence after anterior neck and brain surgery. Patients in the dislocation group were younger (52.6 ± 14.4 vs 58.2 ± 14.2 yrs, P = 0.025), more likely to be female (78.8 vs 56.5%, P = 0.014), and more likely to be intubated by a first-year anaesthesia resident (33.3 vs 18.5%, P = 0.048) compared to those in the non-dislocation group. Patient positions during surgery were significantly different between the groups (P = 0.000). Multivariable Poisson regression identified head-neck positioning (incidence rate ratio [IRR], 3.10; 95% confidence interval [CI], 1.50–6.25, P = 0.002), endotracheal intubation by a first-year anaesthesia resident (IRR, 2.30; 95% CI, 1.07–4.64, P = 0.024), and female (IRR, 3.05; 95% CI, 1.38–7.73, P = 0.010) as risk factors for arytenoid dislocation. Conclusion This study showed that the incidence of arytenoid dislocation was 0.13%, and that head-neck positioning during surgery, less anaesthetist experience, and female were significantly associated with arytenoid dislocation in patients who underwent surgeries under general anaesthesia with endotracheal intubation.
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Affiliation(s)
- Eun-A Jang
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Kyung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Seongheon Lee
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Seung Won Song
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Eugene Jung
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea
| | - Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea.
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501 746, Korea.
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Zhang X, Ma S, Sun X, Zhang Y, Chen W, Chang Q, Pan H, Zhang X, Shen L, Huang Y. Composition and risk assessment of perioperative patient safety incidents reported by anesthesiologists from 2009 to 2019: a single-center retrospective cohort study. BMC Anesthesiol 2021; 21:8. [PMID: 33413123 PMCID: PMC7789294 DOI: 10.1186/s12871-020-01226-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Patient safety incident (PSI) reporting has been an important means of improving patient safety and enhancing organizational quality control. Reports of anesthesia-related incidents are of great value for analysis to improve perioperative patient safety. However, the utilization of incident data is far from sufficient, especially in developing countries such as China. Methods All PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and August 2019 were collected from the incident reporting system. We reviewed the freeform text reports, supplemented with information from the patient medical record system. Composition analysis and risk assessment were performed. Results In total, 847 PSIs were voluntarily reported by anesthesiologists during the study period among 452,974 anesthetic procedures, with a reported incidence of 0.17%. Patients with a worse ASA physical status were more likely to be involved in a PSI. The most common type of incident was related to the airway (N = 208, 27%), followed by the heart, brain and vascular system (N = 99, 13%) and pharmacological incidents (N = 79, 10%). Those preventable incidents with extreme or high risk were identified through risk assessment to serve as a reference for the implementation of more standard operating procedures by the department. Conclusions This study describes the characteristics of 847 PSIs voluntarily reported by anesthesiologists within eleven years in a Chinese academic hospital. Airway incidents constitute the majority of incidents reported by anesthesiologists. Underreporting is common in China, and the importance of summarizing and utilizing anesthesia incident data should be scrutinized.
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Affiliation(s)
- Xue Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Shuang Ma
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Xueqin Sun
- Department of West Campus Medical Affairs, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Damucang Alley 41#, Xicheng District, Beijing, China
| | - Yuelun Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, Beijing, China
| | - Weiyun Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Qing Chang
- Department of Medical Affairs, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, Beijing, China
| | - Hui Pan
- Department of Medical Affairs, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, Beijing, China
| | - Xiuhua Zhang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China.
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1#, Dongcheng District, 100730, Beijing, China
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Nakadate Y, Takamino A, Nakashige D, Ikemoto K. Role of postoperative anaesthesia visits in hoarseness following surgery. Indian J Anaesth 2021; 65:901-905. [PMID: 35221363 PMCID: PMC8820325 DOI: 10.4103/ija.ija_589_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/19/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
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Cho E, Kim HC, Lee JM, Park JH, Ha N, Hong JH, Lee J. Evaluation of transmitted glow point at a priori chosen depth (1 cm below vocal cords) for lightwand intubation: a prospective observational study. J Int Med Res 2020; 48:300060520974249. [PMID: 33284717 PMCID: PMC7724411 DOI: 10.1177/0300060520974249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective When performing lightwand intubation, an improper transmitted glow position
before tube advancement can cause intubation failure or laryngeal injury.
This study was performed to explore the transmitted glow point corresponding
to a priori chosen depth for lightwand intubation. Methods Before lightwand intubation, we marked the transmitted glow point from a
bronchoscope on the neck when it reached 1 cm below the vocal cords.
Lightwand intubation was then performed using this marking point. The
distances from the mark to the upper border of the thyroid cartilage, upper
border of the cricoid cartilage, and suprasternal notch were measured. Results In total, 107 patients were enrolled. The success rate of lightwand
intubation using the mark was 93.5% (95% confidence interval, 88.7%–99.2%)
at the first attempt. The marking point was placed 12.0 mm (95% confidence
interval, 10.6–13.4 mm) below the upper border of the cricoid cartilage. Conclusion Anaesthesiologists should be aware of the appropriate point of the
transmitted glow on the patient’s neck when performing lightwand intubation.
We suggest that this point is approximately 1 cm below the upper border of
the cricoid cartilage. Trial registration: ClinicalTrials.gov NCT03480035
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Affiliation(s)
- Eunyoung Cho
- Department of Anesthesiology and Pain Medicine, Keimyung
University Dongsan Hospital, Keimyung University School of Medicine, Daegu,
Korea
| | - Hyun-Chang Kim
- Department of Anesthesiology and Pain Medicine, Yonsei
University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University
College of Medicine, Seoul, Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae
Medical Center, Seoul National University College of Medicine, Seoul,
Korea
| | - Ji-Hoon Park
- Department of Anesthesiology and Pain Medicine, Keimyung
University Dongsan Hospital, Keimyung University School of Medicine, Daegu,
Korea
| | - Najeong Ha
- Department of Anesthesiology and Pain Medicine, Keimyung
University Dongsan Hospital, Keimyung University School of Medicine, Daegu,
Korea
| | - Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung
University Dongsan Hospital, Keimyung University School of Medicine, Daegu,
Korea
| | - Jiwon Lee
- Department of Anesthesiology and Pain Medicine, Keimyung
University Dongsan Hospital, Keimyung University School of Medicine, Daegu,
Korea
- Department of Anesthesiology and Pain Medicine, Yonsei
University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
- Anesthesia and Pain Research Institute, Yonsei University
College of Medicine, Seoul, Korea
- Jiwon Lee, Department of Anesthesiology and
Pain Medicine, Yonsei University College of Medicine, Gangnam Severance
Hospital, 211 Eonjuro, Gangnam-gu, Seoul 06273, Korea. Emails:
,
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12
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Wang L, Peng WP, Yan CL, Zuo MZ. Arytenoid dislocation after i-gel laryngeal mask insertion was resolved by closed reduction. J Clin Anesth 2020; 66:109915. [PMID: 32563072 DOI: 10.1016/j.jclinane.2020.109915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/07/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Lin Wang
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China
| | - Wen-Ping Peng
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China
| | - Chun-Ling Yan
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China.
| | - Ming-Zhang Zuo
- Department of anesthesia, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China.
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13
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Wang JA, Xu X, Ma Y, Zhuang P, Wang Y. Application of 4D-CT Scanning in Differential Diagnosis of Arytenoid Subluxation and Vocal Fold Paralysis. J Voice 2020; 36:859-867. [DOI: 10.1016/j.jvoice.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
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Frosolini A, Marioni G, Maiolino L, de Filippis C, Lovato A. Current management of arytenoid sub-luxation and dislocation. Eur Arch Otorhinolaryngol 2020; 277:2977-2986. [PMID: 32447498 DOI: 10.1007/s00405-020-06042-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To review the current management of arytenoid subluxation/dislocation (AS/AD) focusing on diagnostic, therapeutic, and prognostic controversies. METHODS The international literature of the last 20 years has been considered. After the application of inclusion criteria, 20 studies were selected (471 AS/AD cases in total). RESULTS All the included investigations were retrospective case series. AS/AD was often iatrogenic occurring at least in 0.01% of patients undergone endo-tracheal intubation. The most common symptom was persistent hoarseness. The diagnosis was made by video-laryngoscopy and neck computed tomography in most reports, while some used also laryngeal electromyography. Laryngeal electromyography was fundamental to rule out unilateral vocal fold paralysis, the main differential diagnosis. The surgical relocation of AS/AD under general or local anesthesia was achieved in about 80% of patients. CONCLUSION AS/AD is a mechanical disorder of the larynx that can be successfully treated if promptly diagnosed. Clinical trials and multi-centric studies are necessary to set management guidelines.
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Affiliation(s)
- Andrea Frosolini
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - Gino Marioni
- Otolaryngology Unit, Department of Neuroscience DNS, University of Padova, Padova, Italy
| | - Luigi Maiolino
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Cosimo de Filippis
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy
| | - Andrea Lovato
- Audiology Unit at Treviso Hospital, Department of Neuroscience DNS, University of Padova, Piazzale Ospedale 1, 31100, Treviso, Italy.
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15
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Liu K, Yingwang J, Zhang L, Li B, Dai J, Wang X. A Rare Complication Following Anesthesia: Arytenoid Dislocation During Orthognathic Surgery. J Oral Maxillofac Surg 2019; 77:959-964. [PMID: 30611687 DOI: 10.1016/j.joms.2018.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Arytenoid dislocation is a rare complication after tracheal intubation, and there are no published studies reporting on arytenoid dislocation during orthognathic surgery. The frequency of this phenomenon and the results of therapy were evaluated in this study. MATERIALS AND METHODS Three of 5,032 patients who underwent orthognathic surgery during an 11-year period had a postoperative arytenoid dislocation. Closed reduction was used in these 3 patients. To check the therapeutic effect, arytenoid dislocation symptoms were recorded and acoustic analysis was performed before reduction, immediately after reduction, and 1, 2, and 4 weeks after reduction. RESULTS The incidence of arytenoid dislocation in orthognathic surgery was 0.0596%. The symptoms of 2 patients showed marked improvement 2 weeks after reduction with voice recovery and resolution of odynophagia. The symptoms of the other patient showed marked improvement 4 weeks after reduction. The treatment effects for all 3 patients were satisfactory. CONCLUSION Arytenoid dislocation must be considered in cases of prolonged hoarseness after orthognathic surgery. Examination should be carried out as soon as possible, which can hasten the treatment of arytenoid dislocation and achieve a good outcome.
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Affiliation(s)
- Kai Liu
- Attending Physician, Department of Oral and Craniomaxillofacial Surgery, Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Researcher, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Junzi Yingwang
- Resident, Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Researcher, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Lei Zhang
- Professor, Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Professor, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Biao Li
- Attending Physician, Department of Oral and Craniomaxillofacial Surgery, Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Researcher, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Jiewen Dai
- Professor, Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Professor, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China
| | - Xudong Wang
- Professor and Chair, Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Professor, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology; National Clinical Research Center for Oral Diseases, Shanghai, China.
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