Question

After total thyroidectomy, the surgeon is unable to extubate and the patient shows cyanosis and respiratory distress. Cause of unable to extubate this

• A. Bilateral recurrent laryngeal nerve palsy
• B. UL recurrent laryngeal nerve palsy
• C. Hemorrhage
• D. Supra laryngeal nerve palsy

Answer 1

The Correct Option is A

After a total thyroidectomy, the patient's inability to be extubated followed by cyanosis and respiratory distress is most likely due to bilateral recurrent laryngeal nerve palsy.

• Bilateral recurrent laryngeal nerve palsy: This condition occurs when both recurrent laryngeal nerves are damaged. The recurrent laryngeal nerves are responsible for controlling most of the intrinsic muscles of the larynx, which are involved in breathing, phonation, and protection of the airway. When bilateral paralysis occurs, the vocal cords can be in a median or paramedian position, leading to airway obstruction, as they cannot abduct effectively during inspiration, resulting in respiratory distress and potential cyanosis.
• Unilateral recurrent laryngeal nerve palsy: This usually results in a hoarse voice and potential dysphonia, but not in acute respiratory distress, as the contralateral vocal cord can usually compensate somewhat.
• Hemorrhage: While a post-operative hemorrhage can cause airway obstruction, the presentation typically includes neck swelling and other signs of bleeding rather than isolated failure to extubate and immediate cyanosis.
• Supra laryngeal nerve palsy: This affects the superior laryngeal nerve, which mainly innervates the cricothyroid muscle affecting voice pitch, but it does not cause significant respiratory distress immediately after the surgery.

Therefore, the immediate inability to extubate the patient combined with cyanosis and respiratory distress strongly suggests bilateral recurrent laryngeal nerve palsy as the cause.