Lu Y H, Hsieh M W, Tong Y H
Division of Anesthesia, Taichung Hospital, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1999 Dec;37(4):221-4.
A 41-year-old man of ASA physical status class I was scheduled to receive the video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris. The elective surgery was performed smoothly under general anesthesia with endotracheal intubation. However, the patient complained of hoarseness in the postoperative period. A stroboscopic examination showed that the left vocal cord remained stationary in the paramedian position, signifying left vocal cord paralysis. In the case, we believed it was most likely that endotracheal intubation might be responsible for the unilateral vocal cord paralysis. The possible cause was that during placement or thereafter during positioning, the endotracheal tube was malposed or slipped upward, rendering its inflated cuff to rest against the vocal cords. Another reason was that the cuff which was over inflated made the vocal cords under constant pressure. Both conditions may cause damage to the anterior branch of the recurrent laryngeal nerve. We also discussed the general management and prophylaxis for the unilateral vocal cord paralysis.
一名41岁的美国麻醉医师协会（ASA）身体状况I级男性患者计划接受电视辅助胸腔镜下T2交感神经切除术治疗手掌多汗症。择期手术在气管插管全身麻醉下顺利进行。然而，患者术后出现声音嘶哑。频闪喉镜检查显示左侧声带固定于旁正中位，提示左侧声带麻痹。在该病例中，我们认为气管插管很可能是导致单侧声带麻痹的原因。可能的原因是在放置气管插管过程中或之后的体位摆放时，气管插管位置不当或向上滑动，使其充气套囊压迫声带。另一个原因是套囊过度充气使声带持续受压。这两种情况都可能导致喉返神经前支受损。我们还讨论了单侧声带麻痹的一般处理和预防措施。
