Introduction

 

 

Thyroid surgery may be associated with two serious complications: recurrent laryngeal nerve (RLN) damage and postoperative secondary bleeding (6). The continuous refinement of surgical techniques (including identification and exposure of the RLN and neuromonitoring of vocal cord muscle responsiveness) has lowered the incidence of RLN damage (2, 3).  Even when performed by surgeons experienced in endocrine surgery, RLN damage may further occur leading to adverse patient outcome (2, 8).  

 

Direct laryngoscopy (DL) may be used by the anesthetist following tracheal extubation to evaluate vocal cord function, particularly when both RLNs were at high risk for damage. Lacoste and co-workers (7) demonstrated, that flexible endoscopy-assisted laryngoscopy is easier to perform, more effective, and associated with less stress to the patient than DL.

 

The purpose of this communication is to describe the use of the Lo Pro Adult GlideScope Video Laryngoscope (LGVL; manufactured by Verathon Medical,  Bothell, Washington, United States) for verification (and documentation as video clip) of bilateral RLN damage during tracheal extubation (with minimal patient discomfort) and immediate tracheal reintubation. The LGVL allows for the transmission of a video image to a monitor, enabling the operator (and others) to visualize anatomical structures of the laryngeal aperture not necessarily in the line-of-sight with conventional laryngoscopy (4, 5). Tracheal extubation under videolaryngoscopic view was then used also in other patients with high risk of RLN damage and/or preoperative unilateral vocal cord palsy.   

 

 

Clinical Features