Position: Supine, Bed turned 180 degrees
Time: 1-2 hours (average)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Contraindicated

Preop – be sure to warn the patient that they will be somewhat awake through part of the procedure. The surgeon will ask them to phonate (say the letter EEEEEE)

Initial Sedation – Sedation is important at the beginning of the procedure. Recommended is low-dose propofol and precedex. Low-dose remifentanil is also recommended if the patient has coughing issues. Once sedated, local anesthetic will be injected over the larynx where the incision is planned, and cocaine-soaked pledgets will be put into the nasal passages. After these are completed, sedation is then reduced/turned off.

Phonation – Fiberoptics are passed through the nasal passages (usually by someone other than anesthesia) to observe the larynx/phonation. The surgeon will place a device and ask the patient to phonate (the patient will be asked to say the letter EEEEEE).

Final sedation – Once the device is placed, the patient will be sedated once more to allow closure.

180 degree turns (general considerations): Arrange lines and monitor cords in anticipation to turn. If turning right, keep cords and lines draped to the left. If turning left, keep cords and lines draped to the right. Have a circuit extension connected. Disconnect the circuit when turning and immediately reconnect.

In this surgery, they will alter the thyroid cartilage in order to change the length and/or position of the vocal cords. This surgery is performed to try and improve phonation (voice).