Bilateral Vocal Cord Palsy During Carotid Endarterectomy Under Cervical Plexus Block

Abstract

We describe a case of vocal cord palsy leading to respiratory obstruction during carotid endarterectomy under cervical plexus block in a patient who had preexisting contralateral vocal cord paralysis subsequent to a previous thyroidectomy. The patient required immediate tracheal intubation and subsequent tracheostomy to maintain the airway postoperatively. Care must be given to avoid contralateral vocal cord paralysis in the presence of a preexisting vocal cord palsy.

Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications †

“…*Indicates that comparisons between deep and superficial block for each category of complication were statistically significant; NS indicates not statistically significant. Bourke and Thomas 13 0/1 0/1 0/1 Carling and Simmonds 18 2/2 2/2 1/2 Goldberg 43 1/1 0/1 0/1 Grundy and colleagues 45 0/1 0/1 1/1 Harris and Benveniste 48 2/2 0/2 0/2 Cockroft and Brownlow 21 0/28 0/28 0/28 Carling and Simmonds 19 1/81 0/81 0/81 Johnson 52 1/1 0/1 0/1 Kwok and colleagues 54 1/1 1/1 0/1 Levelle and Martinez 60 1/1 1/1 2/2 Madi-Jebara and colleagues 63 0/2 0/2 0/2 Spiegelberger and colleagues 99 0/2 0/2 1/2 Stoneham and Wakefield 103 1/1 0/1 0/1 Stoneham and Bree 101 0/1 0/1 0/1 Weiss and colleagues 109 1 expected, there was no difference in the incidence of serious systemic complications between the blocks. Before we consider the implications of these results for clinical practice, it is important to consider some limitations and strengths of the methods of our review.…”

“…Harbaugh 47 2 2/632 Muskett and colleagues 75 1 1/30 Peitzman and colleagues 83 1 1/252 Benjamin and colleagues 9 1 1/81 Bergeron and colleagues 10 1 1/67 Castresana and colleagues 20 1 1/28 Davies and colleagues 26 5 1 2 8/1000 Dawson and colleagues 27 1 1/26 Lawrence and colleagues 57 1 1/200 Molnar and colleagues 73 1 1/40 Tissot and colleagues 108 1 1/15 Carling and Simmonds 18 1 1 2/2 Goldberg 43 1 1/1 Harris and Benveniste 48 2 2/2 Carling and Simmonds 19 1 1/81 Johnson 52 1 1/1 Kwok and colleagues 54 1 1/1 Levelle and Martinez 60 1 1/2 Stoneham and Wakefield 103 1 1/1 Weiss and colleagues 109 Comparison of complications of superficial vs deep cervical block main databases it is unlikely that we have missed large or important studies. It is a strength of our systematic approach that we obtained data from non-surgical, nonanaesthetic, and relatively obscure sources.…”

Analgesic Effects of Ultrasound-Guided Serratus-Intercostal Plane Block and Ultrasound-Guided Intermediate Cervical Plexus Block After Single-Incision Transaxillary Robotic Thyroidectomy

“…During the USG intermediate CPB, we placed the needle tip well out of the carotid sheath in the intermuscular fascial plane, because we did not want to affect the cranial nerves with local anesthetics, such as the vagus, recurrent laryngeal, and facial nerves, which are all located in the vicinity of the carotid artery and trachea. [17][18][19] Superpore dressings (Bandgold Co, Gwangmyeong, Korea) covered the actual or estimated needle insertion site of the intermediate CPB for all patients for the purpose of blinding them to the procedure.…”

Extubation and Reintubation of the Difficult Airway

“…It is suspected that she had a previously unrecognized contralateral vocal cord palsy from a prior thyroidectomy. 193 In this case, the vocal cord dysfunction was co-incident with retraction of the carotid sheath-although it can also be induced by a cervical plexus block-but it raises the importance of the preoperative assessment of patients who have had prior head and neck surgery.…”