Improving Airway Safety and Efficiency in Autologous Fat Injection Laryngoplasty: A Nurse-Led Quality Improvement Initiative.

PURPOSE: Autologous fat injection laryngoplasty (AFIL) presents unique perianesthesia challenges, including shared airway management and risks of laryngocardiac reflex. This quality improvement (QI) initiative aimed to evaluate the efficacy of a standardized perianesthesia nursing protocol in optimizing airway safety and postanesthesia care unit (PACU) outcomes.

DESIGN

A needs assessment and quality improvement project conducted at a single tertiary center.

METHODS

A multidisciplinary nursing protocol was implemented for 21 consecutive patients undergoing AFIL (2020 to 2024). The intervention featured three core phases as follows: (1) Preoperative readiness with standardized equipment checklists; (2) Intraoperative airway collaboration and rapid response preparation for vagal reflexes; and (3) A PACU "smooth emergence bundle" (including multimodal analgesia and noise reduction) to prevent agitation and graft migration.

FINDINGS: The protocol ensured 100% surgical completion without permanent sequelae. Intraoperatively, the nursing team successfully identified and managed severe vagal reflex events (bradycardia/asystole) in 2 patients (9.5%) using the rapid response algorithm. In the PACU, no incidents of glottic obstruction, severe agitation, or abdominal donor site complications were observed.

CONCLUSIONS

Within our specific institutional setting, the implementation of a standardized nurse-led protocol effectively mitigated the specific airway and hemodynamic risks associated with AFIL for this patient cohort. The framework highlights the critical role of perianesthesia nurses in ensuring safety during laryngeal suspension and promoting graft stability during emergence.