Paradoxical Vocal Cord Motion: a Postoperative Dilemma

Paradoxical vocal cord motion (PVCM) is a dysfunction more often seen by otolaryngologists, but of which the anesthesiologist must also be aware of in order to prevent inappropriate invasive airway interventions. For the anesthesiologist, PVCM is most often seen as inspiratory stridor during the postoperative recovery period. Unfortunately, inspiratory stridor can also be a sentinel of impending respiratory failure, and so it is crucial that the serious etiologies be efficiently ruled out. Presented is a case of postoperative PVCM, diagnosed by direct fiberoptic examination, in which timely recognition of this benign, psychogenic postoperative complication resulted in effective and appropriate noninvasive management.