Abstract Bilateral recurrent laryngeal nerve (RLN) injury is a rare complication of thyroidectomy. Close post-operative care is recommended as airway obstruction may require emergent intervention. The authors present a case of bilateral vocal cord palsy. Case report 86 years-old, ASA II patient proposed for thyroidectomy due to multinodular goitter. Neck CT revealed slight right deviation of the trachea without apparent compression. Otolaryngology evaluation with videolaringoscopy prior to surgery revealed normal vocal cord movement. General anaesthesia was administered with propofol (TCI) and REMIfentanil and muscle relaxation was achieved with Rocuronium. A 7.0 endotracheal tube was inserted after direct laryngoscopy without complications. The procedure was performed uneventualy and the patient was extubated and transferred to the Post-Anaesthesia Care Unit (PACU) clinically stable. After 30 minutes in the PACU, the patient presented temporary restlessness and stridor that disappear after calming the patient and breathing control. All monitorization was normal. The patient was kept in this unit for 24 hours reporting occasional stridor, that improved with head elevation. 8 Hours after being transferred to the ward assymptomatic, the patient presented stridor and respiratory distress. Videolaringoscopy demonstrated bilateral vocal cord palsy and urgent tracheotomy was performed. Patient was de-cannulated after 14 days with recovery of left vocal cord function. Discussion Thyroidectomy post-operative period can be complicated with airway obstruction. Various hypothesis should be considered when vocal cord palsy is present at videolaringoscopy, such as bilateral RLN injury. Although a rare complication, known risk factors include thyroid malignancies, reinterventions and large goitters1. Patients usually present with stridor, dyspnea and dysphonia but symptoms can be subtle as severity depend on the remaning vocal cords function and position2. Learning points Although rare, bilateral RLN should be considered as one of the possible causes of post-thyroidectomy respiratory distress.
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