Summary
Objective
In order to establish the ideal anesthetic protocol in thyroplasty type I surgery,
where the intraoperative voice test is used to guide the medialization of the paralyzed
fold, we have studied the effects of a sedation with midazolam premedication and adjusted
intravenous doses of propofol and remifentanil on voice quality in patients without
vocal fold pathology undergoing otorhinolaryngology surgery other than thyroplasty.
Study design
Prospective cross-sectional study included 40 adult patients.
Method
A voice recording was performed when the patient was fully awake and when an appropriate
level of conscious sedation was reached. Following premedication with midazolam at
anxiolytic doses, remifentanil and propofol were administrated by target controlled
infusion pumps (TCI). These results were compared with those obtained in a previous
study carried out by the same team using intravenous bolus (IV) according to weight.
The recorded voice analysis was performed using the computer program Praat (v.5.3.39)
for a sustained vowel.
Results
All the parameters obtained from the acoustic analysis of the voice were altered after
sedation with target controlled infusion in a statistically significant way. Comparing
with bolus intravenous, harmonic and noise ratio (HNR) was the only parameter that
decreased less in the TCI group.
Conclusion
The state of sedation obtained using midazolam premedication, propofol and remifentanil
adjusted intravenous doses alters significantly all the voice parameters, although
this alteration is considerably less than the changes produced by the medication administered
in bolus IV. According to these results, the sedation and the voice test during thyroplasty
surgery would present a series of limitations when it comes to guiding the medialization
of the paralyzed vocal fold and therefore it could not be considered as the ideal
anesthetic protocol in thyroplasty surgery.
Key Words
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Article info
Publication history
Published online: March 07, 2023
Accepted:
January 17,
2023
Publication stage
In Press Corrected ProofFootnotes
The study does not require funding.
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
