RESUMEN
Bilateral vocal cord paralysis is a rare and preventable complication of anterior cervical discectomy and fusion. Herein, we report a fatal case of bilateral vocal cord paralysis after anterior cervical discectomy and fusionI [ACD/F]. A 65-year-old man with cervical spine trauma and anterior cord syndrome, following car overturn presented to our emergency department. The patient had C6-T10 prolapsed discs for which ACD/F was performed. In the recovery room he developed stridor and respiratory distress immediately after extubation, and was reintubated. Otolaryngological evaluation revealed bilateral vocal cord paralysis. He later required a tracheostomy but finally died in a rehabilitation center after an acute coronary event. Awake fibroptic intubation is recommended in patients at high risk for preoperative recurrent laryngeal nerve injury. Intraoperative tracheal tube cuff pressure monitoring and modification of surgical approach to neck are recommended to prevent bilateral nerve damage
RESUMEN
To evaluate the efficacy of preoperative intravenous or peritonsillar infiltration of ketamine for postoperative pain control in children following adenotonsillectomy. Patients and 78 children between 5 and 18 years of age who were scheduled for elective adenotonsillectomy were randomly assigned to four groups: group 1 [n=19] received intravenous ketamine [0.5 mg/kg], group 2 [n=21] intravenous normal saline, group 3 [n=19] ketamine [0.5 mg/kg] injected through the tonsillar capsule, and group 4 [n=19] normal saline injected in the same location. The incidence of postoperative pain and vomiting as well as the severity of postoperative pain were compared between study groups during the 6-hour postoperative period using a visual analog scale [VAS] at rest, upon swallowing saliva, drinking liquids and eating ice cream. There were no demographic differences between the four groups. The incidence of postoperative pain was significantly lower in groups 1 [7 [36.8%] vs. 10 [47.6%]; p=0.032] and 3 [5 [31.5%] vs. 12 [63.2%]; p=0.001] compared with their controls. The amount [in milligrams] of pethidine and metoclopramide used for pain and nausea control was significantly lower in groups 1 [12.5 +/- 5.3 vs. 19.6 +/- 9.6 mg, p=0.038, and 2.9 +/- 1.1 vs. 4.6 +/- 2.6 mg, p=0.042, respectively] and 3 [8.6 +/- 3.1 vs. 21.6 +/- 8.4 mg, p<0.001, and 1.6 +/- 0.9 vs. 5.3 +/- 3.2 mg, p=0.002, respectively] compared with their controls. These values were also higher in group 1 compared with group 3. The VAS scores on swallowing saliva [3.9 +/- 2.7 vs. 2.7 +/- 1.2; p=0.018], on drinking liquids [3.7 +/- 2.6 vs. 2.8 +/- 1.6; p=0.013] and on eating ice-cream [4.3 +/- 2.4 vs. 2.8 +/- 1.5; p=0.001] were also significantly higher in group 1 compared with group 3. Conclusions: Our results show that peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity, need for analgesics and need for antiemetics. Thus, peritonsillar infiltration of ketamine is suggested for postoperative pain control in those undergoing adenotonsillectomy