Anesth Pain Med.  2020 Apr;15(2):226-232. 10.17085/apm.2020.15.2.226.

Vocal cord paralysis following general anesthesia with endotracheal intubation: a clinical review on 43 cases

• Lim S
• Kim Dc
• Cho K
• Kim Mh
• Moon S
• Cho H
• Ki S

• KMID: 2500976
• DOI: http://doi.org/10.17085/apm.2020.15.2.226

Abstract

Background
Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia.
Methods
We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery.
Results
The mean age of patients with VCP was 51.28 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination.
Conclusions
We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.

Keyword

Endotracheal intubation; General anesthesia; Vocal cord paralysis

Figure

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  Fig. 1. Laryngoscopic views of vocal cord paralysis (VCP). (A) Unilateral (right) VCP, (B) bilateral VCP. Above pictures are of VCP patients who occurred at our hospital.

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  Fig. 2. Distribution of vocal cord paralysis patients by operation time. Operation time: length of operation, “operation time = n” means that length of operation is ‘n – 1’ h or more and less than ‘n’ (e.g., 3: 2 h ≤ operation time < 3 h).

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  Fig. 3. Symptoms complained by vocal cord paralysis patients. The complaining symptoms were counted in duplicate.

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  Fig. 4. Distribution of vocal cord paralysis (VCP) patients by prognosis and progress. Grey: patients who did not have follow-up observation after seeing otolaryngology examination only once, Green: patients recovered spontaneously, Blue: patients had treatment with vocal cord injection, Orange: patients had VCP until the last laryngoscopic examination.

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