Elizabeth McIntyre
 Beaumont Health System, Royal Oak, MI 48073, USA
Title:  Postoperative Care of a Patient with Acute Bilateral Vocal Cord Paralysis
Biography
Biography: Elizabeth McIntyre
Abstract
Recurrent laryngeal nerve (RLN) paralysis is an uncommon complication of regional blockade of the brachial plexus at the level of the interscalenes. Ipsilateral placement of a peripheral nerve catheter (PNC) in patients with a history of unilateral vocal cord (VC) paralysis is not contraindicated, however, contralateral placement of PNC should be avoided as bilateral VC paralysis may occur. Postoperative management of a patient with bilateral VC paralysis includes multidisciplinary monitoring of the airway and removal of the PNC. A 79 year old female with a past medical history of hypothyroidism and arthritis presented to the surgical intensive care unit (SICU) with respiratory distress, stridor, and impending respiratory failure requiring reintubation after receiving a right interscalene PNC for shoulder arthroplasty. While in the SICU, a previously unknown history of left VC paralysis after total thyroidectomy was elicited from the patient’s family (this was previously treated with cord medialization). The PNC was removed, and patient remained intubated until effects of long acting local anesthetic were diminished. Patient was taken to the operating room for direct laryngoscopy and found to have unilateral chronic left VC paralysis with resolution of temporary right VC paralysis, presumably from interscalene PNC. In patients with a known history of unilateral VC paralysis, regional blockade to the contralateral interscalene is contraindicated. While rare, RLN paralysis as a sequelae of an interscalene PNC can cause temporary or permanent ipsilateral VC paralysis. Healthcare providers caring for patients with bilateral VC paralysis should consider historical injuries as well as regional techniques that may have contributed to the acute condition. In this case, temporary RLN paralysis was alleviated with removal of the interscalene PNC and supportive care was provided until ENT was able to directly visualize an improvement in vocal cord motion and extubation was tolerated.