Preoperative virtual screening examination of the airway.

A case of a preoperative airway examination performed using telemedicine is presented. The use of this technology has the ability to provide crucial information regarding the feasibility of office-based anesthesia in advance and limit schedule interruptions on the day of surgery.

Vocal cord paralysis after aortic surgery.

OBJECTIVE: The purpose of this study was to investigate variables associated with vocal cord paralysis during complex aortic procedures. DESIGN: A retrospective review. SETTING: A tertiary care center. PARTICIPANTS: Four hundred ninety-eight patients who underwent aortic surgery between 2002 and 2007. METHODS: Two groups were studied. Group A patients had procedures only involving their aortic root and/or ascending aorta. Group B patients had procedures only involving their aortic arch and/or descending aorta. RESULTS: The incidence of vocal cord paralysis was higher (7.26% v 0.8%) in group B patients (p < 0.0001). Increasing the duration of cardiopulmonary bypass time was associated with an increased risk of vocal cord paralysis and death in both groups A and B (p = 0.0002 and 0.002, respectively). Additionally, within group B, descending aneurysms emerged as an independent risk factor associated with vocal cord paralysis (p = 0.03). Length of stay was statistically significantly longer among group A patients who suffered vocal cord paralysis (p = 0.017) and trended toward significance in group B patients who suffered vocal cord paralysis (p = 0.059). The association between tracheostomy and vocal cord paralysis among group A patients reached statistical significance (p = 0.007) and trended toward significance in group B patients (p = 0.057). CONCLUSIONS: Increasing duration of cardiopulmonary bypass time was associated with a higher risk of vocal cord paralysis in patients undergoing aortic surgery. Additionally, within group B patients, descending aortic aneurysm was an independent risk factor associated with vocal cord paralysis. Most importantly, vocal cord paralysis appeared to have an association between an increased length of stay and tracheostomy among a select group of patients undergoing aortic surgery.