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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1998 August;39(4):455-9

CARDIAC PAPERS 

    ORIGINAL ARTICLES

Hoarseness ­after car­diac sur­gery

Inada T., Fujise K., Shingu K.

From ­the Department of Anesthesiology, Kansai Medical University Hospital, Moriguchi, Osaka, Japan

Objective. To inves­ti­gate ­the inci­dence, sever­ity, ­and dura­tion of hoarse­ness ­after ­adult car­diac sur­gery ­and to exam­ine move­ment of ­the endo­tra­cheal ­tube (ETT) dur­ing ­neck exten­sion ­for ster­not­o­my.
Design. Prospective ­study.
Setting. University hos­pi­tal.
Patients. Seventy-­two ­adults under­go­ing elec­tive car­diac sur­gery (assess­ment of hoarse­ness ­was com­plet­ed in 68).
Interventions. An ­ETT ­with an inter­nal diam­e­ter of 8.0 mm ­and 7.5 mm ­was ­used ­for ­men ­and wom­en, respec­tive­ly. After sur­gi­cal posi­tion­ing, ­the ­ETT ­was ­placed ­with ­its ­tip ­about 3 cm ­above ­the cari­na.
Measures. ­ETT migra­tion dur­ing posi­tion­ing ­for ster­not­o­my ­was meas­ured ­using a fib­e­rop­tic bron­cho­scope. Hoarseness ­was exam­ined at 6-12 hrs ­after extu­ba­tion.
Results. The ­ETT ­moved ­away ­from ­the cari­na dur­ing sur­gi­cal posi­tion­ing ­and ­the migra­tion ­was 11±6 (1-27) mm [­mean±SD (­range)]. Hoarseness ­occurred in 32% of ­the ­patients (22/68), of ­whom ­five (23%) ­were ­grade 1 on a ­four-­point ­scale (0-3), 14 (64%) ­were ­grade 2, ­and ­three (14%) ­were ­grade 3 (aphon­ic). The dura­tion of hoarse­ness ­was 4±3 (1-14) ­days, ­except in ­one ­patient ­with ­left ­vocal ­cord par­al­y­sis (60 ­days). When ­this ­patient ­was exclud­ed, intu­ba­tion ­time ­was an inde­pen­dent pre­dic­tor of ­the sever­ity of hoarse­ness (p=0.0001).
Conclusions. Hoarseness ­after car­diac sur­gery is com­mon. Most hoarse­ness is tran­sient ­and ­its sever­ity is pre­dict­ed by dura­tion of intu­ba­tion. Positio-ning ­for ster­not­o­my dis­plac­es ­the ­ETT ­cuff ­away ­from ­the cari­na. This ­may ­cause per­sis­tent hoarse­ness ­because dis­placed ­cuff ­from tra­chea to lar­ynx ­may dam­age ­the recur­rent laryn­geal ­nerve or ­vocal ­cords.

language: English


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