We report a case of a child who was scheduled for an emergency ventriculoperitoneal shunt procedure. The patient had a type II Arnold-Chiari malformation (ACM) and associated hydrocephalus and presented with near complete respiratory obstruction from bilateral abductor vocal cord palsy. Early diagnosis and management of airway abnormalities associated with ACM may be lifesaving. Chiari malformations and anesthesia management are discussed.
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