Paradoxical vocal cord motion in the recovery room: A masquerader of pulmonary dysfunction

Purpose: We report a case of paradoxical vocal cord motion as an unusual cause of postoperative strider and wheezing. A means of diagnosis and management is discussed. Clinical findings: A 71-yr-old man developed paradoxical vocal cord motion following uncomplicated hip replacement. He was treated with standard therapy for postoperative strider and wheezing. After extensive evaluation a flexible fibreoptic laryngoscope was used and the vocal cords noted to move paradoxically. This was the cause of his postoperative strider and wheezing. Paradoxical vocal cord motion should be suspected as a cause of postoperative strider and wheezing when the airway is easily maintained by a bag and mask, there is previous history of psychological problems, and there exists an unexplained history of previous postoperative airway distress. The definitive diagnosis may be made using a fibreoptic laryngoscope. In this patient, intubation was deferred and a plan of conservative therapy pursued. Conclusion: Paradoxical vocal cord motion is an unusual cause of postoperative respiratory distress. A definitive diagnosis may be made by the use of a flexible fibreoptic laryngoscope using topical anaesthesia.