Bilateral recurrent laryngeal nerve neuropraxia following laryngeal mask insertion: a rare cause of serious upper airway morbidity

Sacks, M. D.; Marsh, Deborach

doi:10.1046/j.1460-9592.2000.00550.x

Cited by 38 publications

(22 citation statements)

References 19 publications

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“…While the LMA does not exert its pressure on airway mucosa as predictably as an endotracheal tube [9], it has been shown that higher LMA pressures carry an increased risk of airway complications including recurrent laryngeal nerve injury and distortion of pharyngeal anatomy [10,11]. Such complications may be secondary to reduced mucosal perfusion and can lead to postoperative stridor and the need for tracheal intubation with postoperative mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

The laryngeal mask in infants and children: What is the cuff pressure?

Schloss

Rice

Tobias

2012

International Journal of Pediatric Otorhinolaryngology

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Section: Discussionmentioning

confidence: 99%

The laryngeal mask in infants and children: What is the cuff pressure?

Schloss

Rice

Tobias

2012

International Journal of Pediatric Otorhinolaryngology

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“…There has been no report of such a short recovery time as in this case, when vocal cord paralysis developed after endotracheal intubation. There have been several reports, however, about transient bilateral vocal cord paralysis associated with laryngeal mask airway [11,12]; in those reports, the paralysis was diagnosed as recurrent laryngeal nerve neuropraxia, a transient episode of motor paralysis with little or no sensory or autonomic dysfunction. The quick recovery in this case suggests a neuropraxia of the recurrent laryngeal nerve as the most likely diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Transient bilateral vocal cord paralysis after endotracheal intubation with double-lumen tube -A case report-

Jeong

Kim

et al. 2010

Korean J Anesthesiol

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Vocal cord paralysis is one of the most serious anesthetic complications related to endotracheal intubation. The practitioner should take extreme care, as bilateral vocal cord paralysis can obstruct the airway and lead to disastrous respiratory problems. There have been many papers on bilateral vocal cord paralysis after neck surgery, but reports on such a condition after lung surgery are very rare. We report a case of bilateral vocal cord paralysis detected after removal of a double-lumen endotracheal tube in a 67-year-old patient who underwent wedge resection by video-assisted thoracoscopic surgery. We also note that he recovered spontaneously without complications within a day.

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“…Compression secondary to cuff overinflation during anaesthesia using nitrous oxide may be a contributing factor. Increasing cuff pressure due to the diffusion of nitrous oxide may result in a stretching and direct pressure to the recurrent laryngeal and the external branch of the superior laryngeal nerve [7,8]. To ensure the appropriate cuff pressure and avoid overinflation a continuous monitoring should be used.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Bilateral Palsy of Terminal Laryngeal and Pharyngeal Branches of the Vagal Nerve

Nauheimer¹,

Doering²,

Breinlich³

et al. 2008

TOATJ

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We report a rare case of a postoperative bilateral laryngeal and pharyngeal lesion of the extracranial vagal nerve following a routine general anaesthesia in prone position. It documents a possible way of a serious complication depending to the positioning of the patient in prone position. Etiological factors and measures to avoid this rare but critical complication are discussed.For the clinical practise it should give an advice to minimize the risk of injuries by malpositioning.Keywords: Prone position, malpositioning, complications, vagal nerve lesion, general anaesthesia. CASEPerioperative complications such as nerve lesions secondary to malpositioning may lead to severe functional disability of the patient and reduce a successful surgical procedure. These regrettable injuries that result from stretching, retraction and/or compression to soft tissue and peripheral nerves are especially true for surgery in prone position [1,2]. We present this rare case of a postoperative bilateral lesion of the extracranial vagal nerve following a routine general anaesthesia in prone position to demonstrate possible ways in which nerves can be damaged in the perioperative phase.A 56 year old, 62 kg weighted woman with a 2 year history of frequent lower back pain presented increasing pain and hypaesthesia of both lower extremities as well as a dyfunction of the urinary bladder for the last 2 months. Radiological imaging showed the lumbal stenosis of L3/4 and L4/5 and the instable degenerative lumbal spondylodesis of L3-5. The neurological deficits indicated neurosurgical decompression of lumbal stenosis and transpedicular stabilization of the lumbal spondylodesis. At admission to the surgical treatment the patient was in good physiological condition. 4 years ago a chronic lymphatic leukaemia (CLL) was detected. The Bcell CLL was diagnosed in an early stage (smoldering Binet A) and was not treated with systemic chemotherapy. She presented a peripheral leucocyte count of 28,000 per μl, 158,000 thrombocytes per μl and a hemoglobine count of 12,2 g/l. Different surgical procedures such as hysterectomy, and total endoprothesis of the right knee joint secondary to gonarthrosis were performed in the past years without significant complications.We introduced general anaesthesia with 20 μg of Sufentanil, 80 mg of Propofol and 30 mg of Rocuronium. The orotracheal intubation proved to be uncomplicated. The orotracheal *Address correspondence to this author at the Department of Anesthesiology and Intensive Care, Hospital of Ludwigsburg, Posilipostr. 4, D-71640 Ludwigsburg, Germany; E-mail: nauhdi01@kliniken-lb.de tubus measured an internal diameter of 7,0 mm and was fixed on the left side of the mouth. The cuff was inflated with air up to 22 cmH 2 O and cuff pressure was monitored continuously using a manometer connected to the cuff pilot balloon. Anaesthesia was maintained with Isoflurane (0,6-0,7 vol.% in exspiration), air-oxygen-inflation with an oxygen-fraction of 100% before and 50% performed in low flow after positioning ...

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Bilateral recurrent laryngeal nerve neuropraxia following laryngeal mask insertion: a rare cause of serious upper airway morbidity

Abstract: We report the case of a 4-year-old boy who developed bilateral recurrent laryngeal nerve neuropraxia following a routine anaesthetic with a laryngeal mask airway. The possible mechanisms of injury and the ways that this rare but critical complication might be avoided are discussed.

Cited by 38 publications

References 19 publications

The laryngeal mask in infants and children: What is the cuff pressure?

The laryngeal mask in infants and children: What is the cuff pressure?

Transient bilateral vocal cord paralysis after endotracheal intubation with double-lumen tube -A case report-

Postoperative Bilateral Palsy of Terminal Laryngeal and Pharyngeal Branches of the Vagal Nerve

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