Bilateral vocal cord palsy during carotid endarterectomy under cervical plexus block

We describe a case of vocal cord palsy leading to respiratory obstruction during carotid endarterectomy under cervical plexus block in a patient who had preexisting contralateral vocal cord paralysis subsequent to a previous thyroidectomy. The patient required immediate tracheal intubation and subsequent tracheostomy to maintain the airway postoperatively. Care must be given to avoid contralateral vocal cord paralysis in the presence of a preexisting vocal cord palsy.