[Bilateral recurrent laryngeal nerve paralysis in a child following a neurosurgical operation]

We experienced a case of 7-year-old boy who developed bilateral recurrent laryngeal nerve paralysis following an elective neurosurgical operation under oxygen-nitrous oxide-isoflurane anesthesia. He underwent a removal of brain tumor in the supratentorial region on supine position. After the removal of the endotracheal tube in the intensive care unit, he developed marked respiratory effort and inspiratory stridor. A diagnosis of bilateral recurrent laryngeal nerve paralysis was made by a direct diagnostic laryngoscopy. The patient needed continuous care for his airway patency with tracheotomy tube in place, and his normal vocal cord mobility recovered on the 23 rd postoperative day. Common cause of recurrent nerve injury following general anesthesia is either the procedure of endotracheal intubation itself or trauma due to surgical manipulation. In the present case, an endotracheal tube, a transesophageal stethoscope and a nasogastric tube inserted into the narrow laryngeal space might have been a cause of this complication. Moreover, accidental extreme flexion of his neck which occurred during the surgery might also be an additional cause. This case suggests that recurrent laryngeal nerve paralysis due to anesthetic instruments around the larynx is a possible cause of complications during general anesthesia in pediatric patients.