Abstract:
Objective: To create awareness about subclinical bilateral abductor vocal cord palsy that might give a surprise shock to anesthetist during the conduct of anesthesia.

Case history: A 28 year male (ASA1) underwent axillary block for surgery in right hand. After satisfactory sensory blockade surgery was commenced. After 15 minutes patient was sedated with Midazolam and Buprenorphine due to mild discomfort. The patient developed snoring, followed by stridor indicative of airway obstruction. He was initially managed with 100 % oxygen and PPV for half an hour during which he developed pulmonary edema. He was intubated withPropofol and Succinylcholine and treated with Morphine, Frusemide. An interesting finding during intubation was that cords weren't relaxed even after Succinylcholine. He was shifted to ICU for CPAP/PS with ETT, treated with Dexamethasone.

While obtaining informed risk consent from the mother, she gave the history of snoring and whistling sound during sleep / exertion since the age of 2 years for her son. He was advised some surgery by ENT surgeon, for which he wasn’t willing and details of which weren't available. The history was not given during PAC.

ENT opinion was obtained. When the patient recovered from pulmonary edema, he was extubated over FOB and observed. After video laryngoscopy a diagnosis of Bilateral abductor vocal cord palsy was made

Patient was discharged with a caution note / advice about his disease which may be life threatening.