A COMPARISON OF DIRECT, INDIRECT, AND FIBEROPTIC LARYNGOSCOPY TO EVALUATE VOCAL CORD PARALYSIS AFTER THYROID-SURGERY

After thyroidectomy, the anesthesiologist usually performs a laryngosc opy to detect laryngeal edema and nerve palsies. The goal of this stud y was to compare three different methods of laryngeal examination afte r tracheal extubation of the patients. For that purpose, between 1990 and 1995, a prospective series of 1608 patients operated for thyroidec tomy has been studied. The series was divided into 4 groups. In group I (n = 200), four anesthesiologists have evaluated the efficiency of t he immediate postextubation direct laryngoscopy. In group II (n = 100) , one anesthesiologist has compared the direct, indirect, and flexible laryngoscopies in every patient in a fixed and timed fashion. In grou p III (n = 100), the four examiners have evaluated the flexible laryng oscopy at a different timing so as to eliminate the possible temporal relationship of the ease of visualization in group LI. In group TV (n = 1208), the four examiners have evaluated flexible laryngoscopy, on a large scale, at any time during the l-h stay in the recovery room. Sp ecial attention was directed to the patients with known cardiovascular diseases. Direct and indirect laryngoscopies were only effective in 7 6 and 73%, respectively, of the patients, whereas flexible laryngoscop y was effective in 99.6% of them. Flexible laryngoscopy was easy to pe rform in 96.5% of the patients versus 65 and 55% with direct and indir ect laryngoscopies. Finally, variations in monitored cardiovascular pa rameters were significantly lower with flexible and indirect laryngosc opies than with direct laryngoscopy. These mild variations induced by flexible laryngoscopy were well tolerated by patients with known cardi ovascular diseases. Flexible laryngoscopy is the best method for an im mediate laryngoscopic examination after thyroidectomy.