PARADOXICAL VOCAL CORD MOTION IN THE RECOVERY ROOM - A MASQUERADER OFPULMONARY DYSFUNCTION

Purpose: We report a case of paradoxical vocal cord motion as an unusu al cause of postoperative strider and wheezing. A means of diagnosis a nd management is discussed. Clinical findings: A 71-yr-old man develop ed paradoxical vocal cord motion following uncomplicated hip replaceme nt. He was treated with standard therapy for postoperative strider and wheezing. After extensive evaluation a flexible fibreoptic laryngosco pe 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 a nd wheezing when the airway is easily maintained by a bag and mask, th ere is previous history of psychological problems, and there exists an unexplained history of previous postoperative airway distress. The de finitive diagnosis may be made using a fibreoptic laryngoscope. In thi s 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 an aesthesia.