General Anesthesia During Elective Dental Surgery for a Child Born with a Very Low Birth Weight and Unilateral Vocal Cord Paralysis

Abstract

  Vocal cord paralysis is a known complication following tracheal intubation. If paralysis occurs in bilateral vocal cords, it can cause obstruction of the glottic airflow, resulting in respiratory distress and the need for a surgical airway. We report the case of an 8-year-old boy with autism who underwent general anesthesia for the extraction of an impacted tooth. The patient was born with a very low birth weight and had unilateral vocal cord paralysis as a result of long-term intubation. Because of the potential for tracheal intubation to cause vocal cord paralysis on the non-paralyzed side, a laryngeal mask (LMA) was inserted after slow induction. To secure the surgical site, an LMA with a flexible metallic shaft (AuraFlex^TM) was fixed at a distance from the surgical site. General anesthesia was maintained with sevoflurane, and propofol was administered before the end of the surgery. Spontaneous breathing was maintained throughout the operation to avoid aspiration arising from gastroesophageal reflux. Before removing the LMA, a fiberscope was used to confirm that there was no change in the vocal cord. Because this patient had difficulty staying in the hospital and a strong preference for day surgery, he was sent home after adequate confirmation of his recovery from anesthesia and with an emergency response plan fully in place. With the increasing number of dental treatments being performed in children with complex medical needs, it is important to consider carefully whether procedures should be performed on a case-by-case basis and to devise protocols for minimizing potential complications.