Yutaka Tanaka

Yamamoto T, et al. J Dent Anesth Pain Med. 2026 Aug;26(4):365-367. https://doi.org/10.17245/jdapm.2026.26.092

Yamamoto T, et al. J Dent Anesth Pain Med. 2026 Aug;26(4):369-371. https://doi.org/10.17245/jdapm.2026.26.117

Recurrent laryngeal nerve (RLN) paralysis is a rare but clinically significant complication of general anesthesia associated with endotracheal intubation. We report a case of unilateral RLN paralysis that occurred after prolonged neck dissection under general anesthesia. A 77-year-old male patient with a history of hypertension, dyslipidemia, and myocardial infarction underwent right neck dissection and segmental mandibulectomy for mandibular gingival cancer. Tracheostomy was performed after general anesthesia induction, and a spiral endotracheal tube was inserted with the cuff pressure continuously maintained at 28 cmH₂O. The surgery lasted for over 15 h, with the patient’s neck rotated to the right. No intraoperative complications were observed. Postoperatively, the patient presented with hoarseness and was diagnosed with left RLN paralysis. Fiberoptic examination revealed markedly reduced left arytenoid movement with incomplete glottic closure. Improvement in arytenoid mobility was noted on postoperative day (POD) 25 and phonation returned to normal by day 54. The likely mechanisms involve prolonged intubation, neck rotation, and compressive ischemia of the contralateral RLN. This case underscores the importance of careful cuff pressure monitoring and minimization of neck rotation during prolonged surgery to prevent this rare but potentially disabling complication.

Pheochromocytoma is an endocrine tumor characterized by abnormal catecholamine production. We report the anesthetic management of a 47-year-old woman with a history of familial bilateral pheochromocytoma and prior bilateral adrenalectomy, who underwent cyst enucleation under general anesthesia. The patient was on maintenance corticosteroid therapy and presented with suspected local recurrence. Given her adrenal insufficiency and history of hypertension, perioperative care required meticulous hemodynamic monitoring, stress-dose steroid supplementation, and avoidance of exogenous epinephrine. Anesthesia was induced with sevoflurane and remifentanyl, and intraoperative hypotension was successfully managed with ephedrine. Phentolamine was prepared in anticipation of potential catecholaminergic crises. The procedure proceeded uneventfully with stable hemodynamics and no complications. This case underscores the unique anesthetic challenges in managing patients with coexisting adrenal insufficiency and the risk of catecholamine excess. Careful perioperative planning is essential to ensure safety and hemodynamic stability.

Imai Y, et al. J Dent Anesth Pain Med. 2025 Aug;25(4):287-290. https://doi.org/10.17245/jdapm.2025.25.4.287

Yamamoto T, et al. J Dent Anesth Pain Med. 2025 Jun;25(3):223-226. https://doi.org/10.17245/jdapm.2025.25.3.223

Ujita T, et al. J Dent Anesth Pain Med. 2025 Apr;25(2):139-142. https://doi.org/10.17245/jdapm.2025.25.2.139