Awake Intraoperative Voice Adjustment via Cord Medialization Using Remifentanil and Dexmedetomidine: A Case Report
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Abstract
Thyroplasty, the treatment for vocal fold paralysis, is usually managed under local anesthesia with sedation. This poses difficulties for the surgical team, as inadequate suppression of laryngeal reflexes may lead to coughing and laryngeal movement. A rapid offset of sedation is also critical to allow for intraoperative voice assessment and pitch adjustment. This paper describes an anesthetic approach using total intravenous anesthesia with a combination of remifentanil and dexmedetomidine for a patient undergoing the procedure. The elderly patient was able to remain immobile and relaxed with good spontaneous respiration during surgical dissection and was able to emerge and phonate appropriately during voice monitoring. The technique provided a quiet surgical field and improved patient comfort.
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[5] Handlogten KS, Ekbom DC, Hamre MC, Weingarten TN, Schroeder DR, Seelhammer TG. Anesthetic management for medialization laryngoplasty using concurrent infusions of dexmedetomidine, remifentanil, and propofol versus controls. Am J Otolaryngol. 2019; 40(2):147-51.
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[8] Green SM, Roback MG, Krauss B, Emergency Department Ketamine Meta-Analysis Study Group. Laryngospasm during emergency department ketamine sedation: a case-control study. Pediatr Emerg Care. 2010; 26(11):798-802.
[9] Gropper M, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen N, Leslie K. Miller's anesthesia. 9th ed. Elsevier; 2020.
[10] Cullen BF, Stock MC, Ortega RA, Sharar SR, Holt NF, Connor CW, et al. Barash, Cullen, and Stoelting's clinical anesthesia. Wolters Kluwer; 2024.
[11] Reel B, Maani CV. Dexmedetomidine [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513303/
[12] Wang D, He X, Li Z, Tao H, Bi C. The role of dexmedetomidine administered via intravenous infusion as adjunctive therapy to mitigate postoperative delirium and postoperative cognitive dysfunction in elderly patients undergoing regional anesthesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2024; 24(1):73.
[13] Remifentanil use in anaesthesia and critical care [Internet]. WFSA Resource Library. Available from: https://resources.wfsahq.org/atotw/remifentanil-use-in-anaesthesia-and-critical-care/
[14] Sreevastava, D., & Bhargava, A. (2004). Remifentanil hydrochloride : An opioid for the 21st century. Medical Journal Armed Forces India, 60(2), 177–178.
[15] Wang Y, Yan M, He JG, Zhu YM, Hu XS, Li X, et al. A randomized comparison of target-controlled infusion of remifentanil and propofol with desflurane and fentanyl for laryngeal surgery. ORL J Otorhinolaryngol Relat Spec. 2011; 73(1):47-52.
[2] Daniero JJ, Garrett CG, Francis DO. Framework surgery for treatment of unilateral vocal fold paralysis. Curr Otorhinolaryngol Rep. 2014; 2(2):119-30.
[3] Rosero EB, Ozayar E, Mau T, Joshi GP. A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis. J Anesth. 2016; 30(6):1078-81.
[4] Andrade LR, Castiglia YMM. Sedação com dexmedetomidina e remifentanil em anestesia local para monitoração intraoperatória da fala: um relato de caso [Sedation using dexmedetomidine and remifentanil with local anesthesia for intraoperative speech monitoring: a case report]. Braz J Anesthesiol. 2018; 68(5):521-3.
[5] Handlogten KS, Ekbom DC, Hamre MC, Weingarten TN, Schroeder DR, Seelhammer TG. Anesthetic management for medialization laryngoplasty using concurrent infusions of dexmedetomidine, remifentanil, and propofol versus controls. Am J Otolaryngol. 2019; 40(2):147-51.
[6] Folino TB, Parks LJ. Propofol [Internet]. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430884/
[7] Rosenbaum SB, Palacios JL. Ketamine [Internet]. StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470357/
[8] Green SM, Roback MG, Krauss B, Emergency Department Ketamine Meta-Analysis Study Group. Laryngospasm during emergency department ketamine sedation: a case-control study. Pediatr Emerg Care. 2010; 26(11):798-802.
[9] Gropper M, Eriksson L, Fleisher L, Wiener-Kronish J, Cohen N, Leslie K. Miller's anesthesia. 9th ed. Elsevier; 2020.
[10] Cullen BF, Stock MC, Ortega RA, Sharar SR, Holt NF, Connor CW, et al. Barash, Cullen, and Stoelting's clinical anesthesia. Wolters Kluwer; 2024.
[11] Reel B, Maani CV. Dexmedetomidine [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513303/
[12] Wang D, He X, Li Z, Tao H, Bi C. The role of dexmedetomidine administered via intravenous infusion as adjunctive therapy to mitigate postoperative delirium and postoperative cognitive dysfunction in elderly patients undergoing regional anesthesia: a meta-analysis of randomized controlled trials. BMC Anesthesiol. 2024; 24(1):73.
[13] Remifentanil use in anaesthesia and critical care [Internet]. WFSA Resource Library. Available from: https://resources.wfsahq.org/atotw/remifentanil-use-in-anaesthesia-and-critical-care/
[14] Sreevastava, D., & Bhargava, A. (2004). Remifentanil hydrochloride : An opioid for the 21st century. Medical Journal Armed Forces India, 60(2), 177–178.
[15] Wang Y, Yan M, He JG, Zhu YM, Hu XS, Li X, et al. A randomized comparison of target-controlled infusion of remifentanil and propofol with desflurane and fentanyl for laryngeal surgery. ORL J Otorhinolaryngol Relat Spec. 2011; 73(1):47-52.
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| Section | Case Report(s) | |
| Keywords | ||
| Intravenous anesthesia laryngoplasty intraoperative monitoring vocal cords remifentanil dexmedetomidine | ||
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How to Cite
1.
Astorga PB, Cruz PL. Awake Intraoperative Voice Adjustment via Cord Medialization Using Remifentanil and Dexmedetomidine: A Case Report. Arch Anesth & Crit Care. 2026;.
