Is clinical examination an adequate predictor of respiratory dysfunction after bilateral carotid endarterectomy?

One of the most feared complications in performing bilateral carotid endart erectomies on patients with bilateral high grade stenosis is vocal cord par alysis with resultant respiratory dysfunction. This has led most surgeons t o perform staged carotid endarterectomies separated by 4 to 6 weeks. The pu rpose of this study is to evaluate respiratory risks postoperatively in pat ients who have undergone bilateral carotid endarterectomies during the same admission with clinical examination to evaluate vocal cord function. From January 1993 to January 1998, a total of 512 bilateral carotid endarterecto mies were performed in 256 patients during a single admission. Operative in dications included asymptomatic carotid stenosis 334 (65%), transient ische mic attacks (TIAs) 71 (14%), amaurosis fugax 34 (6.6%), and 33 (6.5%) previ ous stroke. Data were collected prospectively and included patient demograp hics, indications for surgery, and operative complications. patients were e valuated following initial carotid endarterectomy by physical examination. Those patients with hoarseness were then examined by direct laryngoscopy to evaluate the presence of vocal cord paralysis. If no contraindications wer e found on physical examination, patients underwent contralateral carotid e ndarterectomy within 48 hours of the initial procedure. Operative mortality rate was 1.6% (four patients). There was one permanent neurologic deficit and one cranial nerve injury after second carotid endarterectomy (0,3%). Si x patients had contralateral surgery delayed secondary to hoarseness (2.3%) , four with vocal cord dysfunction, and 10 (3.9%) had transient neurologic deficits that improved by the time of their discharge from the hospital. No patient in this study period had respiratory collapse or was compromised a fter bilateral carotid endarterectomy during the same admission. Bilateral carotid endarterectomy can be performed safely with acceptable results duri ng one hospital admission. There does not appear to be an increased inciden ce of upper respiratory dysfunction after bilateral carotid endarterectomy that is performed during the same hospital admission. Clinical examination appears to be adequate in predicting respiratory and vocal cord dysfunction postoperatively.