Successful Treatment of Paradoxical Vocal Cord Motion with Sub-dissociative Dose Ketamine: Case Report.

Paradoxical vocal cord motion (PVCM) is a neuropsychiatric condition often mistaken for asthma or airway blockage. A 23-year-old woman with an acute PVCM attack did not improve with standard benzodiazepine treatment. She received a low (sub-dissociative) dose of intravenous ketamine, which resolved her symptoms and allowed her to leave the emergency department. The authors suggest that sub-dissociative ketamine may be a safe and effective option for PVCM flare-ups, and they discuss patient factors that may have influenced the successful outcome.

Study at a glance

Abstract

Paradoxical vocal cord motion (PVCM) is a primarily neuropsychiatric condition that causes inappropriate adduction of the vocal cords during respiration. This condition is commonly misdiagnosed and treated as refractory asthma or upper airway obstruction requiring intensive care unit-level of care. Recent expert opinion suggests that ketamine administration may promote PVCM symptom resolution; however, this phenomenon has not yet been documented in the literature. This is the case of a 23-year-old female who presented to the emergency department (ED) with acute PVCM exacerbation. After failing to respond to standard-of-care therapies including benzodiazepines, the patient was administered intravenous, sub-dissociative dose ketamine, which led to symptom resolution and discharge. Sub-dissociative dose ketamine may be a safe and effective therapy for PVCM exacerbations in the ED. In this report we explore the patient factors that likely mediated the clinical outcome in this case.