A case of persistent dysphasia after carotid endarterectomy

A 66-year-old man was scheduled for left carotid endarterectomy (CEA). Prior to CEA, he had received CABG. Although the patient had been intubated over 26 hours with an endotracheal tube (ETT; L D. 8.5 mm), he did not complain of hoarseness. For the current operatioa his airway was evaluated as Mallampati score II. The patient was classified as ASA-PS Class 3. Four days before the operatioa both cilostazol and warfarin were withdrawn and heparin infusion was commenced. Aspirin was continued. According to our conventional strategy, general anesthesia was chosea Tracheal intubation was facilitated with rocuronium; but rocuronium was not supplemented. Under direct observation with Macintosh laryngoscope, the patient was intubated with a standard ETT (LD. 7.5 mm). Then the patient was positioned supine with neck extension and his head was rotated to the right for 35 degree over 244 minutes. He was extubated 320 minutes after intubation and started complaining of hoarseness and dysphagia On postoperative day (POD) 5, fiberscope observation revealed submucosal hematoma of the false vocal cord compressing the left recurrent nerve. Deglutition function gradually recovered through rehabilitatioa On POD 21, he was discharged During CEA, laryngeal tissue might have been compressed by ETT because of the forced head-rotated position with neck extension.