Bilateral vocal cord paralysis in a patient with chronic renal failure associated with Alport syndrome

A 61-year-old woman with chronic renal failure (CRF) associated with Alport syndrome underwent coronary artery aneurysmectomy under general anesthesia. Hemorrhage control was difficult during the surgery, and she became hemodynamically unstable. The surgery and anesthesia lasted 446 and 552 min, respectively. On postoperative day 1, she developed severe respiratory distress several minutes after extubation. Her trachea was immediately reintubated. The second attempt to extubate her trachea also failed. Fiberoptic examination revealed bilateral vocal cord paralysis (VCP) due to recurrent laryngeal nerve (RLN) paralysis. Although she needed a temporary tracheostomy, vocal cord movement recovered without treatment 3 months after surgery. The mechanisms underlying her symptoms may be multifactorial: the first and foremost factor was that she had been receiving maintenance hemodialysis for 20 years since being diagnosed with Alport syndrome. We speculated that RLN vulnerability due to Alport syndrome and CRF strengthened her symptoms. We also recognized that the long-lasting mechanical stress and low perfusion to the RLN due to hemodynamic instability during surgery were indispensable contributory factors to the development of VCP. This is the first report of postoperative bilateral VCP in a patient with CRF related to Alport syndrome. Based on this experience, we strongly recommend preoperative detailed examination of vocal cord function in patients with CRF associated with Alport syndrome.