1/12. General anaesthesia for thyroplasty.A new anaesthetic technique is described for thyroplasty. Thyroplasty was performed to restore the voice in unilateral vocal cord paralysis. After skin incision and dissection down to the larynx, a window was cut in the thyroid ala and a silastic wedge used to displace the vocal cord medially. The required size of this wedge was determined by pre-operative computerized tomography scanning of the larynx. At this point the patient had to be awake and cooperative to allow repeated phonation to facilitate correct displacement of the vocal cord.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/12. Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia.A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
3/12. recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block.We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
4/12. Bilateral adductor vocal cord paresis following endotracheal intubation for general anaesthesia.recurrent laryngeal nerve palsy is a rare complication of endotracheal intubation. We report a case of bilateral vocal cord palsy following endotracheal intubation for general anaesthesia. The clinical picture was of hoarseness and aspiration suggestingpartialparesis, as complete bilateral recurrent laryngeal nerve palsy usually causes acute airway obstruction due to unopposed vocal cord adduction. Compression of the anterior branch of the recurrent laryngeal nerve between the cuff of the endotracheal tube and the posterior part of the thyroid cartilage was the likely mechanism. Ensuring that the cuff of the endotracheal tube is distal to the cricoid cartilage and that the pressure in the cuff is kept to the minimum required to prevent a gas leak should prevent this complication.- - - - - - - - - - ranking = 1.25keywords = anaesthesia (Clic here for more details about this article) |
5/12. Acute respiratory failure after deep cervical plexus block for carotid endarterectomy as a result of bilateral recurrent laryngeal nerve paralysis.We report about a case of acute respiratory distress (73-year-old female), which occurred minutes after a deep cervical plexus block (40 ml ropivacaine 0.5%) for carotid endarterectomy (CEA) and required immediate endotracheal intubation of the patient's trachea and consecutive mechanical ventilation. Subsequently, CEA was performed under general anaesthesia (TIVA) with continuous monitoring by somatosensory-evoked potentials. After a period of 14 hours, the endotracheal tube could be removed, the patient being in fair respiratory, cardiocirculatory and neurological conditions. Retrospectively, acute respiratory distress was caused by a combination of ipsilateral plexus blockade-induced and pre-existing asymptomatic contralateral recurrent laryngeal nerve (RLN) paralysis confirmed by a postoperative ENT-check and related to previous thyroid surgery more than 50 years ago. RLN paralysis, often being asymptomatic, represents a typical complication of thyroid and other neck surgery with reported incidences of 0.5-3%. Therefore, a thorough preoperative airway check is advisable in all patients scheduled for a cervical plexus block. Particularly in cases with a history of respiratory disorders or previous neck surgery a vocal cord examination is recommended, and the use of a superficial cervical plexus block may lower the risk of respiratory complications. This may prevent a possibly life-threatening coincidence of ipsilateral plexus blockade-induced and pre-existing asymptomatic contralateral RLN paralysis.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
6/12. Acute upper airway obstruction following Teflon injection of a vocal cord; the value of nebulized adrenaline and a helium/oxygen mixture in its management.A 67-year-old man presented with a 45-year history of a week voice. This was result of polio which had left him with a right vocal cord palsy. The patient underwent a Teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice. In the immediate post-operative period, he suffered acute upper airway obstruction. The problem of acute upper airway obstruction following Teflon injection is considered and its management with nebulized adrenaline and a helium/oxygen mixture is discussed.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
7/12. recurrent laryngeal nerve palsy following heart-lung transplantation: three cases of vocal cord augmentation in the acute phase.Three cases of left recurrent laryngeal nerve palsy following heart-lung transplantation are described. In each case, within twelve hours of extubation, the left vocal cord was injected with Teflon, and the paralyzed vocal cord thus displaced to the midline. Effective closure of the glottis was then possible, permitting an adequate cough, adequate clearing of the bronchial tree and minimising the risk of aspiration. Augmentation under general anaesthesia as soon as possible after discovery of vocal cord dysfunction is advocated. Suitable materials for injection are discussed. To our knowledge, this is the first reported series of vocal cord augmentation in the acute phase following heart-lung transplantation.- - - - - - - - - - ranking = 0.25keywords = anaesthesia (Clic here for more details about this article) |
8/12. Respiratory obstruction following vocal cord injection. A complication on induction of anaesthesia.Two patients who each had a paralysed left vocal cord are discussed. Both had poor coughing ability preoperatively. The affected cords had been injected with tetrafluoroethylene (Teflon) paste 3 days before operation and this had given immediate improvement in coughing and speech. During induction of anaesthesia, respiratory obstruction occurred that was related to the injected cord. This cause of obstruction has not been reported previously. The potential benefits of cord injection for voice, cough and laryngeal competence are reviewed.- - - - - - - - - - ranking = 1.25keywords = anaesthesia (Clic here for more details about this article) |
9/12. vocal cord paralysis associated with difficult gastric tube insertion.Many clinical reports have described vocal cord paralysis after general anaesthesia. In most cases, paralysis was attributed to tracheal tube insertion. In this report we describe one patient in whom gastric tube insertion was strongly suspected as the cause of paralysis. The patient was a 47-yr-old man who underwent left hepatic lobectomy. Just after the operation he complained of hoarseness and a diagnosis of complete right vocal cord paralysis was made, from which he recovered after eight weeks. In this patient, insertion of the gastric tube seemed to have injured the anterior ramus of the right recurrent laryngeal nerve directly. Although there have been several reports of vocal cord paralysis induced by gastric tubes, none has noted such an acute onset and direct nerve injury. Therefore we would like to report this rare case and elucidate the mechanism of vocal cord paralysis. Careful attention should be paid in inserting a gastric tube to patients under general anaesthesia and, sometimes, the use of the soft tube may be indicated.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
10/12. Vocal fold palsy after use of the laryngeal mask airway.We report two cases of left vocal fold palsy following use of the laryngeal mask airway. In both cases anaesthesia was uneventful with a duration of about 60 minutes. It is proposed that high intra-cuff pressures induced during anaesthesia resulted in distension of the hypopharynx and subsequent neuropraxia of the motor branches of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
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