Bilateral recurrent laryngeal nerve (RLN) injury is rare for benign thyroid lesions (0.2%). After extubation-stridor, respiratory distress, aphonia occurs due to the closure of the glottic aperture necessitating immediate intervention and emergency intubation or tracheostomy. Intra-operative identification and preservation of the RLN minimizes the risk of injury. It is customary to expect RLN problems after thyroid surgery especially if malignancy, big thyroid, distorted anatomical problems and difficult airway that can lead to intubation trauma. Soon after extubating, it is essential to the anesthetist to check the vocal cord movements on phonation and oropharyngeal reflexes competency. But this case is specially mentioned to convey the message that in spite of absence of above mentioned predisposing factors for complications and good recovery profile specific to thyroid, there can be unanticipated airway compromise that if not attended to immediately may cost patient's life. This is a case of postextubation stridor following subtotal thyroidectomy due to bilateral RLN damage and its management.

AIMThe aim of the study is to compare the onset and quality of analgesia in combined spinal epidural technique in single interspace versus sole epidural technique in attaining labour analgesia in primiparous women. METHODSSixty primiparous women between age group of 20-35 years were randomly divided into two groups. Group A patients received Combined Spinal Epidural using "Needle through needle technique" and were given 2ml of 0.125% isobaric levobupivacaine with 25mcg of fentanyl for subarachnoid block and 0.125% levobupivacaine with 1mcg/ml fentanyl at 8ml/hr for epidural maintenance. Group B patients received sole epidural block initially with 6ml of 0.125% levobupivacaine with 25mcg of fentanyl through Tuohy needle as a bolus to achieve labor analgesia. Later, 0.125% isobaric levobupivacaine with 1mcg/ml fentanyl at 8ml/hr was given as continuous epidural infusion to extend analgesia. RESULTSA controlled study was undertaken to compare Group A with Group B for labour analgesia. The labour analgesia occurred significantly early in group A when compared to group B. The total amount of Levobupivacaine required to attain the same target level was two times in Group A (p<0.05). Haemodynamic changes were comparable in both the groups. No neurological side effects were observed. In conclusion, sequential CSE is superior alternative to epidural block, which combines the advantages of spinal and epidural while minimizing their drawbacks.