VOCAL CORD PARALYSIS ASSOCIATED WITH DIFFICULT GASTRIC TUBE INSERTION

Marry clinical reports have described vocal cord paralysis after gener al anaesthesia. In most cases, paralysis was attributed to tracheal tu be insertion. In this report we describe one patient in whom gastric t ube insertion was strongly suspected as the cause of paralysis. The pa tient was a 47-yr-old man who underwent left hepatic lobectomy. Just a fter the operation he complained of hoarseness and a diagnosis of comp lete right vocal cord paralysis was made, from which he recovered afte r eight weeks. In this patient, insertion of the gastric tube seemed t o have injured the anterior ramus of the right recurrent laryngeal ner ve directly. Although there have been several reports of vocal cord pa ralysis induced by gastric tubes, none has noted such an acute onset a nd direct nerve injury. Therefore we would like to report this rare ca se and elucidate the mechanism of vocal cord paralysis. Careful attent ion should be paid in inserting a gastric tube to patients under gener al anaesthesia and, sometimes, the use of the soft tube may be indicat ed.