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Aphonia following tracheal intubation: An unanticipated post-operative complication

Indian Journal of Anaesthesia
Medknow Publications
Publication Date
DOI: 10.4103/0019-5049.115578
  • Brief Communication
  • Medicine


INTRODUCTION Tracheal intubation is a routine procedure performed by anaesthesiologists. Complications following this procedure are not uncommon and include sore throat, hoarseness of voice, dysphagia, etc. They are minor and resolve spontaneously or with minimal intervention. However, aphonia secondary to vocal cord paralysis following tracheal intubation is a rare complication during routine surgeries, more commonly encountered after thyroid surgeries.[12] Though not fully understood, certain risk factors have been proposed to explain this phenomenon such as advanced age, comorbid conditions, use of nitrous oxide, patient positioning and difficult intubation. With certain simple measures such as use of appropriately sized endotracheal tube (ETT), monitoring cuff pressure intra-operatively and diligent patient positioning, the occurrence of this complication can be minimized. We report three cases of aphonia secondary to vocal cord involvement, following tracheal intubation, encountered over a period of 12 years in our institute. CASE REPORTS Case 1 A 32-year-old male patient with Mallampati (MP) I airway was posted for elective laparotomy for excision of hepatic flexure mass. Patient was intubated with 8.5 mm internal diameter (ID) ETT in first attempt. Hoarseness of voice was noted 3 h after extubation and indirect laryngoscopy (IDL) revealed right vocal cord palsy. There was spontaneous resolution of the condition in 40 days. Case 2 A 38-year-old male patient with MP II airway was posted for surgery with multiple fractures of right upper limb and soft-tissue injuries on the scalp and face. Patient was intubated with 9 mm ID ETT in first attempt. Patient could not phonate after extubation and IDL revealed wavy distortion of both vocal cords. Patient regained normal voice over 60 days. Case 3 A 42-year-old obese female patient with MP III and short neck received general anaesthesia for incisional

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