Case Report: A 30 year old lady came with thyroid swelling, 4x3x3 cm in size, on left side of neck. swelling was attached neither to the skin nor to the underlying structure. Swelling was not pulsatile, there was no retrostenal extension of the swelling. No tracheal deviation. There was no regional lymphadenopathy. Airway appeared normal. Routine investigations were also normal. Ultrasound Sonogram neck revealed 2.5x1.4 cm nodule with cystic areas and micro calcified focui. Papillary thyroid carcinoma was confirmed by FNAC. Thyroid profile was Euthyroid. Cystic lesion in the right sublentiform area was revealed by MRI brain.

Anaesthetic Management: Anti Parkinsoniandurgs and premedication were given. NIBP, ECG, ETCO2, Heart Rate and SPO2 were monitored. After preoxygenation, fentonyl and propofal induction, intubation was facilitated with vecuronium. Subsequent doses of anti parkinsonian drugs were administered through naso gastric tube. Anaesthesia was maintained with oxygen isoflurane and continous infusion of propofal. Smooth emergence was noted after reversal and there were no signs of muscle regidity.

Discussion: Problems in Parkinsonian is neurological, respiratory and cardio vascular. Succinylcholine was avoided as it can cause hyperkalemia. Fentanyl can cause muscle regidity so was used judiciously. Intravenous Ldopa can cause arrythmia and hypertension. So tablet Ldopa was preferred and administrered through naso gastric tube Intraoperatively and postoperatively to prevent exaberations of symptoms of Parkinsonian.

Conclusion: The anaesthetic management of parkinsonism described above is practical, easy and prevented the exaberation of the symptoms.