Surgeon gets blamed for anesthesia complication

[pgg]

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Stop the presses

https://www.npr.org/2026/06/03/nx-s1-5648779/they-went-through-my-vocal-cords-barry-manilow-recovers-after-lung-cancer-surgery

Barry Manilow had lung cancer and a lobectomy -

As if that diagnosis wasn't scary enough, the singer says surgeons had to pass through his vocal cords on their way to excising a portion of his lung. "They promised me that they were very gentle and they didn't hurt my vocal cords," he said. "But I'm not so sure."

No anesthesia details but presumably he got the usual gigantic DLT crammed through his vocal cords.


So - in general, maybe singers might be better off with a SLT and bronchial blocker?

 

[aneftp]

Stop the presses

https://www.npr.org/2026/06/03/nx-s1-5648779/they-went-through-my-vocal-cords-barry-manilow-recovers-after-lung-cancer-surgery

Barry Manilow had lung cancer and a lobectomy -



No anesthesia details but presumably he got the usual gigantic DLT crammed through his vocal cords.


So - in general, maybe singers might be better off with a SLT and bronchial blocker?

I’m a big fan of bronchial blockers. Not the old yellow ones but the more modern ones like the teleflex ex blocker. Fuji and ambu have their own blockers which I’ve used as well.

 

[Lab Lover]

Stop the presses

https://www.npr.org/2026/06/03/nx-s1-5648779/they-went-through-my-vocal-cords-barry-manilow-recovers-after-lung-cancer-surgery

Barry Manilow had lung cancer and a lobectomy -



No anesthesia details but presumably he got the usual gigantic DLT crammed through his vocal cords.


So - in general, maybe singers might be better off with a SLT and bronchial blocker?

Permanent voice change has been reported with regular old single lumen tubes and a supposedly uneventful intubations. Just like pro athletes getting nerve blocks, vocalists are almost certainly more sensitive to it.

Julie Andrews Settles Lawsuit Against Doctors

abcnews.com

I can't believe that there wasn't a videotaped informed consent for Julie Andrews. Only slightly joking.

 

[UscGhost]

Anything that folks do differently for singers for regular cases (and cases requiring DLT)?

 

[Lab Lover]

Anything that folks do differently for singers for regular cases (and cases requiring DLT)?

Smaller than usual ETT. I Don't do cases anymore that require single lung ventilation.
Longer than usual informed consent discussion and documentation of same.

 

[Guillemot]

Limiting cuff inflation pressure also important .

 

[cittykat]

Limiting cuff inflation pressure also important .

Assuming the cuff is below the cords, why would that make a difference?

 

[Guillemot]

Assuming the cuff is below the cords, why would that make a difference?

It can cause ischemic damage to the RLN. I cant remember where I originally read about it, but this article also discusses it.

Postintubation recurrent laryngeal nerve palsy: A review : Journal of Laryngology and Voice

is important to identify and monitor these patients to prevent confusion with regard to etiology and outcome. This article explores the etiopathogenesis of recurrent laryngeal nerve palsy following intubation and the various risk factors and possible mechanisms which contribute to this...

journals.lww.com

“Anatomical analysis of recurrent laryngeal nerve palsy was performed by Ellis and Pallister.[<a data-reference-links="R10-1">10</a>] They highlighted the fact that the posterior branch of the recurrent laryngeal nerve innervates the posterior cricoarytenoid and the interarytenoid muscles, while the anterior branch supplied most of the adductors. Cavo[<a data-reference-links="R9-1">9</a>] performed a series of laryngeal dissections which showed that the probable site of injury to the recurrent laryngeal nerve is the subglottic region. In this area, the anterior branch of this nerve is vulnerable to compression between the expanded cuff and the overlying thyroid cartilage on the superoanterior border of the posterior cricoarytenoid muscle, which is about 6–10 mm below the posterior third of true vocal cord. This compression of the recurrent nerve and its peripheral branches in the larynx causes degeneration and subsequent nerve paralysis. Insufficient microcirculatory supply to the nerve and its branches may cause ischemic neuronal degeneration and subsequent paralysis.[<a data-reference-links="R4-1">4</a>]”

 

[narcotics999]

Anything that folks do differently for singers for regular cases (and cases requiring DLT)?

Defer the case to Chief.

 

[Lab Lover]

Defer the case to Chief.

or Academic center down the road. Didn't help the folks at Mount Sinai who did Julie Andrews.

 

[ucsfgaspain]

Dude, priorities. You had lung cancer surgery. It's not like you had facial botox injections at your local med spa. It's called cancer surgery. Surgery to save your life. Hoarseness as a tradeoff for potential cure of something that will kill you is not the worst tradeoff in the world. We (as in medicine) are a victim of our success. Complications have become more rare and thus things are seen as no big deal. Perfect results are now viewed as expectations. Complications happen despite everything being done correctly. Nothing is risk free. People die taking a Sh&t every year. It's rare but it happens. You don't blame people for how they sh^t for the reason for their perish*t death, SO i'm not surprised that recurrent nerve injury happens with such a large denominator of intubations that occur every year. SH$T happens.

In addition. if the mechanism as suggested, bad technique were true. I would surmise that Vocal Cord injury would be more prevalent among specific anesthesia providers. I have not observed this in my career(never had one to my knowledge personally...knock on wood). Seems random and thankfully rare.

 

[CopaceticOne]

Permanent voice change has been reported with regular old single lumen tubes and a supposedly uneventful intubations. Just like pro athletes getting nerve blocks, vocalists are almost certainly more sensitive to it.

Julie Andrews Settles Lawsuit Against Doctors

abcnews.com

I can't believe that there wasn't a videotaped informed consent for Julie Andrews. Only slightly joking.

The craziest part of this is that it was a vocal cord procedure!

 

[pgg]

I would surmise that Vocal Cord injury would be more prevalent among specific anesthesia providers.

Every time I see someone jam a styletted tube with an aggressive hockey stick bend to the hilt into someone's airway, I cringe at what it's doing to the poor patient's trachea.

For gods sake if you're going to use a stylet, pull it once the tip of the tube is past the vocal cords .....

 

[ucsfgaspain]

Every time I see someone jam a styletted tube with an aggressive hockey stick bend to the hilt into someone's airway, I cringe at what it's doing to the poor patient's trachea.

For gods sake if you're going to use a stylet, pull it once the tip of the tube is past the vocal cords .....

It actually gives me a lot of comfort. Means the trachea is a lot more robust than we give it credit for.🙂 I'm sure you've taken over cases and you are like WTF I wouldn't tolerate that level of BP if I started the case, or that level of tachy? But patient makes it out OK no sequelae. It's kind of hard to mess people up. It really centers me in how we tend to overcomplicate things especially academics. I switched from decades in the private world to the pseudoacademic world three years ago. I've really counselled my CA-3's that in the end, keep it simple. Get the godda#n, tube in the right hole, that's 90% of anesthesia. If you don't get that part right. doesn't matter how smart you are or how much you generated an elegant anesthetic plan. You're fuc@*d, and your patient's fuc@#d,.

 

[pgg]

It actually gives me a lot of comfort. Means the trachea is a lot more robust than we give it credit for.🙂 I'm sure you've taken over cases and you are like WTF I wouldn't tolerate that level of BP if I started the case, or that level of tachy? But patient makes it out OK no sequelae. It's kind of hard to mess people up. It really centers me in how we tend to overcomplicate things especially academics. I switched from decades in the private world to the pseudoacademic world three years ago. I've really counselled my CA-3's that in the end, keep it simple. Get the godda#n, tube in the right hole, that's 90% of anesthesia. If you don't get that part right. doesn't matter how smart you are or how much you generated an elegant anesthetic plan. You're fuc@*d, and your patient's fuc@#d,.

Heh, I see where you're coming from, and yeah it's great they didn't stick the tube in the esophagus, but I don't think lip biopsies and tracheal abrasions or just being rough in general are good habits. People are hard to hurt, until they're not.

See also: jamming the Yankauer in and out of the deep oropharynx like it's a sewing machine that owes you money ...

 

[PpfSuxTube]

Dude, priorities. You had lung cancer surgery. It's not like you had facial botox injections at your local med spa. It's called cancer surgery. Surgery to save your life. Hoarseness as a tradeoff for potential cure of something that will kill you is not the worst tradeoff in the world.

While I agree with you, thats irrelevant in some people's view and their lawyers obviously...
Ive had colleagues sued for relatively small complications while other surgeons leave a trail of dead bodies and literally get sent a 16 yr bottle of scotch for "trying"

 

[operaman]

FYI Julie Andrews surgeon is who damaged her cords, not the anesthesiologist. She developed vocal fold nodules during a run of the musical Carousel on broadway. She was doing 8 shows a week of a role that was a bit too low for her and she developed nodules. Other doctors told her to rest and do therapy and step out of the show, but she found a doctor who agreed to surgically remove the nodules promising her she could go back in just a few weeks. Unfortunately he ended up resecting a lot of the lamina propria such that she could barely speak, much less sing post op. Just a terrible avoidable outcome all around.

Whenever I’m doing any operation on a singer, I typically do the intubation myself so I’m the only one touching the cords and any issues are on me. I also do a pretty in depth informed consent process for them in the office as well. I typically just use a straight blade and a 5-0 microlaryngeal tube without stylet for most things.

Not sure what the answer is for DLTs or even bigger SLTs beyond just being gentle and careful. So far I’ve only been asked to help place these for patients with upper airway stenoses who need dilation or something to get the tube in, so none of those folks were doing much singing anyway.

 

[pgg]

She developed vocal fold nodules during a run of the musical Carousel on broadway. She was doing 8 shows a week of a role that was a bit too low for her and she developed nodules.

Username checks out

🙂

 

[LowWafer8]

Every time I see someone jam a styletted tube with an aggressive hockey stick bend to the hilt into someone's airway, I cringe at what it's doing to the poor patient's trachea.

For gods sake if you're going to use a stylet, pull it once the tip of the tube is past the vocal cords .....

Crnas love stylets. Not needed 95% of the time

 

[pgg]

Crnas love stylets. Not needed 95% of the time

Shrug

I stylet most tubes. In the 5% (probably less) of cases where they're helpful or needed I'd rather not put down the laryngoscope and go get one.

 

[coolforschool]

Shrug

I stylet most tubes. In the 5% (probably less) of cases where they're helpful or needed I'd rather not put down the laryngoscope and go get one.

Same. I tried the no-stylet thing straight out of training and got annoyed when I actually needed one in a not-difficult-but-slightly-anterior airway. Better to have it and utilize proper technique (remove prior to advancing) IMO.

What I refuse to use is the gum elastic bougie. Blind insertion in urgent situations is a recipe for disaster. I’ve never needed to use one since I’ve been out of training, and I’ve done high volume ENT/airway stuff for the past several years. Much prefer to mask ventilate while waiting for Glide/fiber instead of jamming one down blindly out of convenience. Unfortunately have had colleagues cause tracheal lacerations or disrupt anastomoses in lung txs with those.

 

[cittykat]

I use a hyperangulated VL (glidescope) for everyone so I use a stylette every time.

 

[glyco4all]

Anything that folks do differently for singers for regular cases (and cases requiring DLT)?

I was requested by a patient to use a supraglottic airway for a septoplasty/turbs. The patient understood that intubation was (obviously) a possibility. The surgeon was careful and kept things pretty dry. Things worked out fine, thankfully.

 

[UscGhost]

I was requested by a patient to use a supraglottic airway for a septoplasty/turbs. The patient understood that intubation was (obviously) a possibility. The surgeon was careful and kept things pretty dry. Things worked out fine, thankfully.

Good idea.

Definitely requires a good surgeon eith good hemostasis. I have done that with a couple surgeons. Other surgeons it would be a disaster..

 

[JoelJoel84]

Do you, or the other docs in this forum, normally intubate for septoplasty or turbinate cases?
Not saying our surgeons are great, but I’ve never seen or done that before, even at several different hospitals (except for some rare patient exception).

 

[UscGhost]

Do you, or the other docs in this forum, normally intubate for septoplasty or turbinate cases?
Not saying our surgeons are great, but I’ve never seen or done that before, even at several different hospitals (except for some rare patient exception).

I routinely intubate.

 

[pgg]

Do you, or the other docs in this forum, normally intubate for septoplasty or turbinate cases?
Not saying our surgeons are great, but I’ve never seen or done that before, even at several different hospitals (except for some rare patient exception).

I mostly favor intubation for any case where someone is mucking about in the airway or face or neck, or if the table is turned and the head draped. So for dental or ENT cases it's a tube 99% of the time.

If I can't easily reach it, or there's someone swinging ham hands or elbows around it, I don't like LMAs.

 

[JoelJoel84]

I mostly favor intubation for any case where someone is mucking about in the airway or face or neck, or if the table is turned and the head draped. So for dental or ENT cases it's a tube 99% of the time.

If I can't easily reach it, or there's someone swinging ham hands or elbows around it, I don't like LMAs.

Fair enough, no criticism, just curious how the other guys do it.

We usually have the head right in front of us , and a septo and/or turbinates is rarely over 30-40 min, so we usually LMA them and suction around at the end.

 

[UscGhost]

Fair enough, no criticism, just curious how the other guys do it.

We usually have the head right in front of us , and a septo and/or turbinates is rarely over 30-40 min, so we usually LMA them and suction around at the end.

Definitely possible if the surgeon is good

 

[amyl]

Not at my current job- not my case-
A crna didn’t pull back the stylet from a 6.5 ett (- of course anesthesiologist wasn’t there because they were spread thin and it was +-loose supervision )
Patient got a tear and TE fistula…. Not good… lesson for the residents - pull the stylets back in smaller tubes

 

[T-burglar]

Glottic injuries are not from the tube, styletted or not, it’s from poor laryngoscopy technique. Eyes rolling out of my head when I overhear someone say they use a miller 3 on everyone . Which means that metal tip goes deep into something before being pulled out on every intubation

 

[T-burglar]

Honestly the best argument imo for video laryngoscopy just becoming standard, if there ever was one

 

[Twiggidy]

One of our techs did an analysis and showed that on a per case basis a McGrath was cheaper and less wasteful than the disposable Mac/Mill blades and handles. The McGrath is nice and I’m considering getting my own like a few of my partners

Re: Manilow and Andrews. It would’ve been a painfully long and drawn out conversation that given their surgery and the need for ventilation/airway protection that some change in voice is almost inevitable. If that doesn’t sound good to you and you’re not okay with that you can shop for another anesthesiologist. In my head I would say ‘it’s just a VATS’ if I lose this case I’ll be alright. But it would be a long conversation, maybe even with the preop nurse present, and they can choose their own adventure.

 

[Burned_Out]

Same. I tried the no-stylet thing straight out of training and got annoyed when I actually needed one in a not-difficult-but-slightly-anterior airway. Better to have it and utilize proper technique (remove prior to advancing) IMO.

What I refuse to use is the gum elastic bougie. Blind insertion in urgent situations is a recipe for disaster. I’ve never needed to use one since I’ve been out of training, and I’ve done high volume ENT/airway stuff for the past several years. Much prefer to mask ventilate while waiting for Glide/fiber instead of jamming one down blindly out of convenience. Unfortunately have had colleagues cause tracheal lacerations or disrupt anastomoses in lung txs with those.

I avoid using stylets routinely by molding my ETT in a circle. Stick the murphy eye end into the other end and form it into a wreath. Then when you go to place it, this puts a natural curve on the end and is perfect for any anterior looking airways.

 

[coffeebythelake]

I avoid using stylets routinely by molding my ETT in a circle. Stick the murphy eye end into the other end and form it into a wreath. Then when you go to place it, this puts a natural curve on the end and is perfect for any anterior looking airways.

Natural curves work on normal airways

 

[IlDestriero]

Shrug

I stylet most tubes. In the 5% (probably less) of cases where they're helpful or needed I'd rather not put down the laryngoscope and go get one.

I stylet nearly 100% of the tubes I place. If I’m supervising, and it’s not an infant, emergency, or potentially difficult, I usually don’t care what they do. I spent several years doing all my own cases. I want the tube in and on to the next thing asap. Old habits die hard. If I need a stylet it’s already there. If I didn’t, who cares?
Having said that, a couple of my partners would loudly whine about the waste, etc. 🙄

 

[cittykat]

Glidescope doesn’t work without a stylette so I stylette every tube.

 

[coffeebythelake]

Glidescope doesn’t work without a stylette so I stylette every tube.

Agree on the need for stylet. Can use a malleable stylet. Don't need to be rigid unless truly expecting difficult and anterior

 

[cittykat]

Agree on the need for stylet. Can use a malleable stylet. Don't need to be rigid unless truly expecting difficult and anterior

That’s what I use. Hook my index finger through the loop and advance tube with my thumb.