Anesthesia can be maintained with propofol or sevoflurane. Volatile anesthetics increase neuromuscular block of muscle relaxants. We tested the hypothesis, that sevoflurane would cause less vocal cord injuries than an intravenous anesthesia with propofol. In this prospective trial, 65 patients were randomized in 2 groups: SEVO group, anesthesia with sevoflurane, and TIVA group, total intravenous anesthesia with propofol. Intubating and extubating conditions were evaluated. Vocal cord injuries were examined by stroboscopy before and 24 and 72 h after surgery; hoarseness and sore throat were assessed up to 72 h after surgery. Hoarseness and sore throat were comparable between both groups (not significant). Similar findings were observed for vocal cord injuries: 9 (SEVO) versus 5 (TIVA) patients; ; the overall incidence was 24%. Type of vocal cord injuries: 9 erythema and 5 edema of the vocal folds. Neuromuscular block was significantly longer in the SEVO group compared with the TIVA group: 71 (range: 38–148) min versus 52 (range: 21–74) min; . Five patients (TIVA group) versus 11 patients (SEVO group) needed neostigmine to achieve a TOF ratio of 1.0 . Under anesthesia with propofol laryngeal injuries were not increased; the risk for residual curarization, however, was lower compared with sevoflurane. 1. Introduction We showed that tracheal intubation with atracurium significantly decreased vocal cord injuries compared with tracheal intubation without muscle relaxants (8% versus 42%) [1]. Tracheal intubation with atracurium at maximum neuromuscular block, however, did not decrease vocal cord injuries compared with tracheal intubation two minutes after injection of atracurium; the overall incidence was 27%, that is, higher than described in the literature (up to 12%) [2]. Maybe vocal cord injuries did not only occur during tracheal intubation but also during surgery and during removal of the tracheal tube. Volatile anesthetics increase neuromuscular block of muscle relaxants; anesthesia induction with desflurane increased neuromuscular block compared with a total intravenous anesthesia [3]. Thus, sevoflurane as part of the anesthesia would increase neuromuscular block; moreover, sevoflurane would lengthen neuromuscular block; vocal cords, therefore, would be longer relaxed. We speculated that sevoflurane would cause less vocal cord injuries than propofol during surgery and after removal of the tracheal tube. After surgery, we assessed hoarseness, sore throat, and vocal cord injuries—by stroboscopy—up to 72 hours. We expected that the patients receiving
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