Airway Management in Patients With Vocal Cord Paralysis: A Review of Intubation Techniques, Intraoperative Challenges, and Outcomes.

Vocal cord paralysis (VCP) presents with unique challenges when managing airways, particularly during endotracheal intubation. This literature review explores the effects of unilateral and bilateral VCP on intubation technique, first-pass success, extubation safety, and perioperative airway planning. While video laryngoscopy (VL) is becoming increasingly favored for its superior airway visualization, it does not always confirm successful placement in patients with VCP. Complications such as airway edema, aspiration risk, and cuff misplacements are increased in this patient population, and they may be more vulnerable to post-extubation complications, especially without the use of steroid prophylaxis or intensive post-operative planning. A comparison of direct laryngoscopy (DL) versus VL in this patient population reveals a gap in the literature, emphasizing the need for more research in airway management in patients with VCP. This review combines current practices, clinical considerations for anesthesia providers, and identifies areas for further investigation.