Paradoxical Vocal Cord Motion terminated by sevoflurane inhalation: a case report and review of the condition

Abstract

SummaryParadoxical vocal cord motion (PVCM) is an episodic and abnormal adduction of the vocal cords giving rise to stridor, wheeze, shortness of breath (SOB), cough and chest tightness. It is often mistaken for asthma so the incidence of the disorder is unknown but it may be as high as 22% in patients who present to the Emergency Department with acute dyspnoea. The pathophysiology of PVCM is not well understood but is thought to include both psychological and physical components. Management is based upon speech and language therapy as well as identifying and removing triggers. A number of strategies aimed at terminating acute episodes have been described, including CPAP, inspiratory valve devices, speech and language techniques, nebulised lidocaine, heliox and benzodiazepines. We describe the case of a 56 year old male with a longstanding history of brittle asthma, in whom an acute episode of PVCM was terminated with sevoflurane, an intervention that averted the need for tracheal intubation.