Document Detail


Bilateral vocal cord paralysis in a patient with chronic renal failure associated with Alport syndrome.
MedLine Citation:
PMID:  20221644     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A 61-year-old woman with chronic renal failure (CRF) associated with Alport syndrome underwent coronary artery aneurysmectomy under general anesthesia. Hemorrhage control was difficult during the surgery, and she became hemodynamically unstable. The surgery and anesthesia lasted 446 and 552 min, respectively. On postoperative day 1, she developed severe respiratory distress several minutes after extubation. Her trachea was immediately reintubated. The second attempt to extubate her trachea also failed. Fiberoptic examination revealed bilateral vocal cord paralysis (VCP) due to recurrent laryngeal nerve (RLN) paralysis. Although she needed a temporary tracheostomy, vocal cord movement recovered without treatment 3 months after surgery. The mechanisms underlying her symptoms may be multifactorial: the first and foremost factor was that she had been receiving maintenance hemodialysis for 20 years since being diagnosed with Alport syndrome. We speculated that RLN vulnerability due to Alport syndrome and CRF strengthened her symptoms. We also recognized that the long-lasting mechanical stress and low perfusion to the RLN due to hemodynamic instability during surgery were indispensable contributory factors to the development of VCP. This is the first report of postoperative bilateral VCP in a patient with CRF related to Alport syndrome. Based on this experience, we strongly recommend preoperative detailed examination of vocal cord function in patients with CRF associated with Alport syndrome.
Authors:
Kazuhiro Watanabe; Keiichi Hagiya; Shinichi Inomata; Masayuki Miyabe; Makoto Tanaka; Taro Mizutani
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-03-11
Journal Detail:
Title:  Journal of anesthesia     Volume:  24     ISSN:  1438-8359     ISO Abbreviation:  J Anesth     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-14     Completed Date:  2010-09-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8905667     Medline TA:  J Anesth     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  472-5     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Critical Care Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan. atenza@jcom.home.ne.jp
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, General
Cardiac Surgical Procedures
Coronary Aneurysm / surgery
Female
Humans
Intubation, Intratracheal / adverse effects
Kidney Failure, Chronic / complications*
Laryngeal Nerves / injuries
Middle Aged
Nephritis, Hereditary / complications*
Postoperative Complications / therapy
Renal Dialysis
Tracheostomy
Vocal Cord Paralysis / complications*,  therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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