Throat polyps are noncancerous growths that can develop on the vocal cords. They often result from vocal abuse, chronic irritation, or, in some cases, unknown causes. While these growths are generally benign, they can lead to a variety of symptoms, like one’s voice sounding breathy, raspy, or hoarse, as well as difficulty swallowing or a persistent cough 1. Anesthesia in patients with throat polyps requires caution and adjustment, especially on the side of airway management.
Before any procedure involving anesthesia, a thorough preoperative assessment is required. In the case of throat polyps, this assessment is particularly important. The anesthesiologist, in collaboration with the proceduralist, will need to assess the size, location, and nature of the polyps. Factors such as the patient’s overall health, comorbidities, and previous responses to anesthesia should also be taken into account.
Airway management is particularly difficult in patients with throat polyps. The presence of these growths may compromise the normal anatomy of the airway, potentially leading to challenges in intubation and ventilation. Alternative approaches should be considered and prepared, such as the use of smaller-sized endotracheal tubes or specialized laryngeal masks, to work with an altered airway anatomy. Some clinicians explicitly suggest the need to maintain spontaneous ventilation until intubation as mask ventilation can be particularly challenging 2. Such patient-targeted approaches are critical to addressing the not uncommon airway obstructions found in this patient population 3,4.
Throat polyps, particularly if large or vascular, may increase the risk of bleeding during surgical procedures, adding another layer of complexity to anesthesia management 5. Techniques such as controlled hypotension may be used to minimize bleeding risks while maintaining sufficient blood flow to vital organs 6.
Most recently, a study reported the use of non-intubated deep paralysis as a new anesthesia strategy for vocal cord polypectomy. This technique involves neuromuscular blockade and anesthesia without intubation. The technique was successfully performed in 95% of patients in the small pilot study, replacing general anesthesia in vocal cord polypectomy. No anesthesia complications occurred without intubation, and patients and surgeons were satisfied with non-intubated deep paralysis.
Anesthesia considerations for patients with throat polyps extend into the postoperative phase, where careful monitoring and management are essential. Patients may be at an increased risk of postoperative complications, including but not limited to tracheal rupture, airway edema or respiratory distress 7,8. Adequate pain management, vigilant monitoring of vital signs, and early detection of any signs of respiratory compromise are crucial components of postoperative care.
Ongoing research is warranted to investigate novel approaches to the administration of anesthesia for patients with throat polyps, including the use of advanced imaging technologies for precise airway assessment and the establishment of tailored anesthetic protocols that minimize risks while optimizing patient outcomes.
In conclusion, managing anesthesia in the presence of throat polyps requires an approach tailored to the unique challenges posed by these growths. Through careful preoperative assessment, meticulous airway management, thoughtful consideration of bleeding risks, and careful postoperative care, anesthesiologists can navigate the complexities associated with throat polyps, ensuring safe and effective anesthesia administration.
References
1. Vocal Cord Polyps, Nodules, Granulomas, Papillomas – Ear, Nose, and Throat Disorders – MSD Manual Consumer Version. Available at: https://www.msdmanuals.com/home/ear,-nose,-and-throat-disorders/laryngeal-disorders/vocal-cord-polyps-nodules-granulomas-papillomas. (Accessed: 30th January 2024)
2. Harshad, P. L., Pujari, V., Channappa, N. M. & Anandaswamy, T. C. Anesthesia management in a child with laryngeal papilloma causing near complete airway obstruction. Saudi J. Anaesth. (2015). doi:10.4103/1658-354X.146322
3. Shergill, G. S. & Shergill, A. K. Large vocal cord polyp: An unusual cause of dyspnoea. BMJ Case Reports (2015). doi:10.1136/bcr-2015-211542
4. Fuseya, S. et al. Airway obstruction due to a laryngeal polyp following insertion of a laryngeal mask airway. JA Clin. Reports (2018). doi:10.1186/s40981-018-0180-3
5. Fan, Y. et al. Non-intubated deep paralysis: a new anaesthesia strategy for vocal cord polypectomy. Perioper. Med. (2023). doi:10.1186/s13741-023-00301-7
6. Tegegne, S. S., Gebregzi, A. H. & Arefayne, N. R. Deliberate hypotension as a mechanism to decrease intraoperative surgical site blood loss in resource limited setting: A systematic review and guideline. International Journal of Surgery Open (2021). doi:10.1016/j.ijso.2020.11.019
7. Hu, X., Chen, X., Cui, X., Cao, Y. & Sun, G. Tracheal rupture after vocal cord polyp resection A case report. Med. (United States) (2021). doi:10.1097/MD.0000000000028106
8. Okui, A., Konomi, U. & Watanabe, Y. Complaints and Complications of Microlaryngoscopic Surgery. J. Voice (2020). doi:10.1016/j.jvoice.2019.05.006