title: Acute vocal fold dystonic reaction to propofol: a case report.
abstract: A 67-year old male underwent uneventful robotic-assisted thoracoscopic resection of a solitary pulmonary fibrous tumor. Immediately following extubation at the completion of the surgical procedure, the patient developed respiratory distress that did not resolve with treatment. Benadryl provided only temporary relief. Midazolam and hydromorphone were given for anxiolysis and analgesia respectively, which provided transient relief of symptoms. Propofol was given to decrease upper airway reflexes. Adequate reversal from nondepolarizing neuromuscular blockade was confirmed with nerve stimulator. A flexible laryngoscope was introduced nasally to visualize the vocal cords, which revealed intermittent tremulousness of the vocal cords, adduction of bilateral vocal cords to the midline, and minimal to absent opening with inspiration, without any apparent injury or blood, saliva, or vomit noted in or around the glottic opening. The patient was then given diazepam and reintubated. Given the patient's history of difficulty breathing after previous surgery and the lack of vocal cord movement, dystonic reaction to propofol was suspected. The patient remained intubated for two hours in the post-anesthesia care unit before being extubated uneventfully.
authors.affiliation: Department of Anesthesiology and Perioperative Care, UCLA Ronald Reagan Medical Center, 757 Westwood Plaza, Los Angeles, California. Electronic address: rsteckelberg@mednet.ucla.edu.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Steckelberg
authors.affiliation: Department of Anesthesiology and Perioperative Care, UCLA Ronald Reagan Medical Center, 757 Westwood Plaza, Los Angeles, California.
authors.forename: David
authors.initials: D
authors.lastname: Tsiang
authors.affiliation: Department of Head and Neck Surgery, UCLA Ronald Reagan Medical Center, 757 Westwood Plaza, Los Angeles, California.
authors.forename: Kelly
authors.initials: K
authors.lastname: Pettijohn
authors.affiliation: Department of Head and Neck Surgery, UCLA Ronald Reagan Medical Center, 757 Westwood Plaza, Los Angeles, California.
authors.forename: Abie
authors.initials: A
authors.lastname: Mendelsohn
authors.affiliation: Department of Anesthesiology and Perioperative Care, UCLA Ronald Reagan Medical Center, 757 Westwood Plaza, Los Angeles, California.
authors.forename: Nir
authors.initials: N
authors.lastname: Hoftman
mesh_terms: D000208:Acute Disease; D000368:Aged; D060666:Airway Extubation; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D018680:Cholinergic Antagonists / Q000008:administration & dosage*; D004421:Dystonia / Q000139:chemically induced / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome; D064706:Vocal Cord Dysfunction / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D014827:Vocal Cords / Q000187:drug effects*
chemical_list: D018686:Anesthetics, Intravenous; D018680:Cholinergic Antagonists; D015742:Propofol