Paradoxical vocal fold motion masquerading as post-anesthetic respiratory distress: A case report

Abstract

BACKGROUND

Functional vocal cord disorders can be a differential diagnosis for postoperative upper airway obstruction requiring urgent intervention. However, this may be unfamiliar to anesthesiologists who would favor inappropriate airway intervention and increased morbidity.

CASE SUMMARY

A 61-year-old woman underwent cervical laminectomy, followed by laparoscopic cholecystectomy 10 mo later. Despite adequate reversal of neuromuscular blockade, the patient experienced repetitive respiratory difficulty with inspiratory stridor after extubation. After the second operation, the patient was diagnosed with paradoxical vocal fold motion (PVFM) by an otolaryngologist based on the clinical features and fiberoptic bronchoscopy results, and the patient was successfully treated.

CONCLUSION

PVFM should be considered a differential diagnosis if a patient presents with stridor after general anesthesia.

Keywords: Anesthesiology; Vocal fold; Paradoxical motion; Postoperative respiratory distress; Case report

Core Tip: Postoperative upper airway obstruction after general anesthesia requires urgent airway intervention. Postoperative stridor is a common cause of laryngeal spasm, but functional vocal cord disorders may also be a cause. However, anesthesiologists may be unfamiliar with functional vocal cord disorders, and this may lead to inappropriate interventions. We present the case of a patient with post-extubation repetitive stridor who was postoperatively diagnosed with paradoxical vocal fold motion (PVFM) by an otolaryngologist and discuss the diagnosis and treatment of PVFM. Our case presentation showed that PVFM should be considered in the differential diagnosis of postoperative stridor.