C-ESI safety with vocal cord dysfunction?

[Baron Samedi]

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I've been trying to find relevant literature but none seems to exist. I have a pending consult for a C-ESI in a patient who has significant vocal cord dysfunction. Any extra safety concerns in performing the procedure? Perhaps do with no local anesthetic, just steroid and saline or perform as normal?

 

[dc2md]

I only use depo/saline mixture for cervical IL ESI anyway.

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[SommeRiver]

Personally, I don't put anesthetic in cervical epidurals and surely cortisone and saline in this pt is without any added risk.

 

[SSdoc33]

no increased risk. vocals cords are in the front, last time i checked

 

[Wkrdoc]

I only use depo/saline mixture for cervical IL ESI anyway.

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Hasn’t everyone gone to Decadron in CESIs?

 

[dc2md]

Hasn’t everyone gone to Decadron in CESIs?

Not for interlaminar. Just transforaminal. There are no feeding arteries to the spinal cord or brainstem in the dorsal epidural fat.

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[clubdeac]

Yeah I'm not sure what risk vocal cord dysfunction poses in this setting. I use depo with saline in my CESIs

 

[thecentral09]

Also deposit with saline

 

[Aether2000]

Stop the advancement of the needle before reaching the vocal cords and usually there will be no vocal cord dysfunction.

 

[Wkrdoc]

Not for interlaminar. Just transforaminal. There are no feeding arteries to the spinal cord or brainstem in the dorsal epidural fat.

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I know this, however, most academic institutions have gone to decadron exclusively for even LESIs. Most attendings I know have followed suit. Is this not what most of you guys are seeing? What’s the benefit of depo medrol over decadron? I saw no difference in outcomes after switching

 

[painfree23]

I use dex , I mean in the off chance ur IT , isn’t depo more dangerous than dex?

 

[lobelsteve]

I use dex , I mean in the off chance ur IT , isn’t depo more dangerous than dex?

If you’re IT and do not recognize it with contrast flow, go back to inpatient PMR or pent sux tube.

 

[Baron Samedi]

Eh guess I was overthinking it. I typically put a bit of local on it(maybe I should stop), so was just thinking about respiratory compromise.

Anyways thanks for advice