Vocal cord paralysis following endotracheal intubation.

A 60 year old lady presented to the emergency room with 2 days history of abdominal distention, colicky pain and constipation. Her chest x-ray showed pneumoperitoneum. She underwent exploratory laparotomy the same day. She was found to have a tumour of the sigmoid colon alongwith caecal perforation. A subtotal colonic resection with ileocolic anastomosis was performed. Her preoperative assessment was ASA III and she was intubated with a red rubber tube with an 8mm cuff It was intubation grade I. The cuff was inflated with room air. During the procedure 02 was kept at 1.5 L/min and N2O2L/min. The procedure took 3 hours after which she was extubated. Her post-anaesthetic recovery was unremarkable. On 2nd postoperation day the patient developed inspiratory stridor. She also became agitated and breathless. The following day she was referred to the ENT department. On fibreoptic laryngoscopy examination both vocal cords were in the paramedian position with slight mobility. She was put under strict observation to evaluate for a possible tracheostomy but on 4th postoperation day her condition started to improve progressively and on the 8th postoperation day another fibreoptic laryngoscopy showed complete left vocal cord paralysis while the right vocal cord had normal mobility. Patient was discharged and repeat fibreoptic laryngoscopy two weeks later found both vocal cords to be mobile and normal.