Unilateral Vocal Cord Paralysis Following Tracheal Extubation: A case report / 대한마취과학회지

We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time.

The Effects of Epidural Bupivacaine and Morphine Mixture on Bowel Motility after Upper Abdominal Surgery / 대한마취과학회지

BACKGROUND: The stress of operation inhibits bowel motility. The blockade of efferent sympathetic nerve is helpful to recovery of bowel motility. So we tried to examine that the extent of sympathetic blockade by alterations of bupivacaine infusion rate affected the recovery of bowel motility. METHODS: Group 1 (N = 25) received postoperative meperidine intramuscular injection on demand as a control group, group 2 (N = 25) received postoperative epidural 0.125% bupivacaine 100 ml plus morphine 10mg by infusion pump, 1 ml/hour, for 4days, group 3 (N = 25) received 0.125% bupivacaine 400 ml plus morphine 10mg by infusion pump, 4 ml/hour, for 4days. The Group 2 and 3 received additional morphine 2mg in 0.2% bupivacaine 10 ml epidurally as a single bolus when the peritoneum was closed. The time interval from termination of operation to the first passage of flatus was estimated. RESULTS: In group 1, bowel motility was regained at 92+/-23 hours, group 2 ; 90+/-19 hours and group 3 ; 91+/-19 hours. All values are not significantly different among the groups (p>0.05). CONCLUSIONS: The alteration of epidural bupivacaine and morphine infusion rate did not affect the recovery of postoperative bowel motility.