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Pulmonary oedema after airway obstruction due to bilateral vocal cord paralysis

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We report a case of pulmonary oedema which developed after airway obstruction due to bilateral vocal cord paralysis. The patient was a 52-yr-old woman undergoing craniotomy for an acoustic neuroma. Anaesthesia was uneventful. Spontaneous ventilation resumed after reversal of neuromuscular blockade. Following extubation she showed signs of airway obstruction and dyspnoea. The trachea was reintubated but she became hypoxic, PaO2 -36mmHg, produced pink frothy secretions and the x-ray was typical of pulmonary oedema. The oedema cleared within 24 hr. Tracheostomy was performed one week later as the cords were still fixed, but the latter had recovered by three months and the tracheostomy was closed. The cause of the cord paralysis is unknown but probably was a result of surgical trauma to the brain stem.


On rapporte le cas d’un patient ayant de’veloppe un a?deme pulmonaire aigue aprés obstruction des voies aeriennes suite à une paralysie bilatérale des cordes vocales. La paliente âgée de 52 ans à subi une craniotomie pour un neuroninone acoustique. L’anesthésie fut accomplie sans incident. La ventilation spontanée fut reprise après antagonisme du blocage neuromusculaire. Apres l’extubation, la patienle à démontré des signes dobstruction des voies aériennes et de la dyspnée. La trachée fut reintubée mais la patiente devint hypoxique, PaO2 −36 mmHg, et on a observé des sécrétions spumeuses rosées et le rayon-x a démontré un adème pulmonaire typique. L’œdéme a régressé en dedans de 24 heures. Une tracheostomie fut faite une semaine plus tard car les cordes vocales étaient encore fermées et la récupération s’ensuivie trois mois plus tard, c’est alors que la trachéostomie fut fermée. La cause de la paralysie des cordes vocales n’est pas connue mais serait due probablement au trauma chirurgical.


  1. 1

    Oswalt CE, Gates GA, Holmstrom FMG. Pulmonary edema as a complication of acute airway obstruction. JAMA 1977; 238: 1833–5.

  2. 2

    Cozanitis DA, Leijala M, Pesonen E, Zaki HA. Acute pulmonary oedema due to laryngeal spasm. Anaesthesia 1982; 37: 1198–9.

  3. 3

    Terry Lee KW, Downes JJ. Pulmonary edema secondary to laryngospasm in children. Anesthesiology 1983; 59: 347–9.

  4. 4

    Weissman C, Damask MC, Yang J. Noncardiac pulmonary edema following laryngeal obstruction. Anesthesiology 1984; 60: 163–5.

  5. 5

    Galvis AG, Stool SE, Bluestone CD. Pulmonary edema following relief of acute upper airway obstruction. Ann Otol Rhino Laryngol 1980; 89: 124–8.

  6. 6

    Travis KW, Todres ID, Shannon DC. Pulmonary edema associated with croup and epiglottitis. Pediatrics 1977; 59: 695–8.

  7. 7

    Oswalt CF, Gates GA, Holmstromm FM. Pulmonary edema as a complication of acute airway obstruction. Review of Surgery 1977; 34: 346–7.

  8. 8

    Jackson FN, Rowland V, Corssen G. Laryngospasm induced pulmonary edema. Chest 1980; 78: 819–21.

  9. 9

    Melnick BM. Posllaryngospasm pulmonary edema in adults. Anesthesiology 1984; 60: 516–7.

  10. 10

    Frank LP, Schreiber GC. Pulmonary edema following upper airway obstruction. Anesthesiology 1986; 65: 106.

  11. 11

    Bachmann P, Gaaurrprgues P, Pignat JC et al. Pulmonary edema secondary to warfarin-induced sublingual and laryngeal hematoma. Crit Care Med 1987; 15: 1074–5.

  12. 12

    Jenkins JG. Pulmonary edema following laryngospasm. Anesthesiology 1984; 60: 611–2.

  13. 13

    Solimann MG, Richer P. Epiglottitis and pulmonary edema in children. Can Anaesth Soc J 1987; 25: 270–5.

  14. 14

    Kanter KR, Watchko JF. Pulmonary edema associated with upper airway obstruction. Am J Dis Child 1984; 138: 356–8.

  15. 15

    Andersen B, Kamir CB, Nielsen KD. Laryngospasminduced pulmonary edema. Acta Anaesthesiol Scand 1988; 32: 710–1.

  16. 16

    Willms D, Shore D. Pulmonary edema due to upper airway obstruction in adults. Chest 1988; 94: 1090–2.

  17. 17

    Sprung CL, Rackow EC, Fein A, Jacob AI, Isikoff SK. The spectrum of pulmonary edema: differentiation of cardiogenic, intermediate, and noncardiogenic forms of pulmonary edema. Am Rev Respir Dis 1981; 124: 718–22.

  18. 18

    Stalcup SA, Mellins RB. Mechanical forces of producing pulmonary edema in acute asthma. N Engl J Med 1977; 297: 592–6.

  19. 19

    Smith-Erichsen N, Bo G. Airway closure and fluid filtration in the lung. Br J Anaesth 1987; 51: 475–9.

  20. 20

    Holly HS, Gildea JE. Vocal cord paralysis after tracheal intubation. JAMA 1971; 215: 281–4.

  21. 21

    Cavo JW Jr. True vocal cord paralysis following intubation. Laryngoscope 1985; 95: 1352–9.

  22. 22

    Brandwein M, Abramson AL, Shikowitz MJ. Bilateral vocal cord paralysis following endotracheal intubation. Arch Otolaryngol Head Neck Surg 1986; 112: 877–82.

  23. 23

    Lim EK, Chia KS, Ng BK. Recurrent laryngeal nerve palsy following endotracheal intubation. Anaesth Intensive Care 1987; 15: 342–5.

  24. 24

    Jordan WS, Graves CL, Elwyn RA. New therapy for postintubation laryngeal edema and (rachitis in children. JAMA 1970: 212: 585–8.

  25. 25

    Lang SA, Duncan PG, Shephard DAE, Ha HC. Pulmonary oedema associated with airway obstruction. Can J Anaeslh 1990; 37: 210–8.

  26. 26

    Brand JB, Emerson CW, Wilson RS. Acute laryngeal edema 24 hours after passage of a nasogastric tube. Anesthesiology 1976; 45: 555–7.

  27. 27

    Pender DJ. Laryngismus fugax: Transient laryngeal spasm secondary to brain stem ischemia. Laryngoscope 1984; 94: 1497–500.

  28. 28

    Shaw GL. Airway obstruction due to bilateral vocal cord paralysis as a complication of stroke. South Med J 1987; 80: 1432–3.

  29. 29

    Wray NP, Nicotra MB. Pathogenesis of ncurogenic pulmonary edema. Am Rev Respir Dis 1978; 118: 783–6.

  30. 30

    Malik AB. Mechanisms of neurogenic pulmonary edema. Circulation Res 1985; 57: 1–18.

  31. 31

    Kreisman NR, Hodin RA, Rosenthal M, Sick TJ. Role of pulmonary edema in phasic changes of cerebral oxygenation during seizures. Brain Res 1987; 417: 335–42.

  32. 32

    Maron MB. Analysis of airway fluid protein concentration in neurogenic pulmonary edema. J Appl Physiol 1987; 62: 470–6.

  33. 33

    Sprung CL, Long WM, Marcial EH et al. Distribution of proteins in pulmonary edema. The value of fractional concentrations. Am Rev Respir Dis 1987; 136: 957–63.

  34. 34

    Artru AA, Cucchiara RF, Messick JM. Cardiorespiratory and cranial-nerve sequelae of surgical procedures involving the posterior-fossa. Anesthesiology 1980; 52: 83–6.

  35. 35

    Holinger PC, Holinger LD, Reichert TJ, Holinger PH. Respiratory obstruction and apnea in infants with bilateral abductor vocal paralysis, meningomyelocele, hydrocephalus, and Arnold-Chiari malformation. J Pediatr 1978; 92: 368–73.

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Correspondence to Shuji Dohi.

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Dohi, S., Okubo, N. & Kondo, Y. Pulmonary oedema after airway obstruction due to bilateral vocal cord paralysis. Can J Anaesth 38, 492–495 (1991). https://doi.org/10.1007/BF03007586

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Key Words

  • airway: obstruction
  • lung: oedema