Surgery-related vocal fold immobility risk in children reassessed
MedWire News: Researchers report that the risk for vocal fold immobility (VFI) in children undergoing cardiothoracic surgery might be less than previously believed.
Frederick Kozak (British Columbia Children's Hospital, Vancouver, Canada) and team explain that in a group of 100 children with a median age of 7.5 months, VFI following cardiothoracic surgery occurred at a rate of 8%.
This rate, say Kozak et al, is much lower than the rate of 9.1-52.2% reported by previous studies.
Furthermore, "the patients in our study with VFI were younger and weighed less than patients with normal vocal fold movement," highlight the researchers in the Archives of Otolaryngology Head and Neck Surgery.
In the study, Kozak and team used flexible laryngoscopy to analyze vocal fold mobility before and up to 72 hours after extubation. All patients underwent laryngoscopy after having a cardiothoracic procedure.
The researchers found that only eight children developed VFI and these children were younger and weighed less than those that did not develop VFI. Indeed, VFI- and non-VFI patients had median respective ages of 0.7 and 7.8 months, and median respective baseline weights of 3.7 kg and 7.5 kg.
Univariate but not multivariate analyses revealed that circulatory arrest and dissection or ligation of the patent ductus arteriosus, descending aorta, or of either pulmonary artery, significantly increased the risk for VFI 2.3-6.9-fold compared with the absence of these factors.
The researchers believe that the association between these variables and VFI risk disappeared on multivariate analyses because there were few VFI patients to include in the analyses.
Of note, no trauma was noted during endotracheal intubation of all the patients and the duration of intubation did not significantly differ between the children that developed VFI and those that did not.
Kozak and colleagues conclude: "Further study with multivariate analyses among more patients is needed to definitively identify factors associated with the outcome of VFI."
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By Lauretta Ihonor