Respiratory Failure Due to Bilateral Vocal Fold Paralysis Following Laparoscopic Cholecystectomy: A Rare Presentation of Myasthenia Gravis.

Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junctions. A 50-year-old woman with well-controlled MG developed stridor and respiratory failure on the first postoperative day after undergoing laparoscopic cholecystectomy with total intravenous anesthesia and sugammadex reversal. During orotracheal intubation, bronchoscopy revealed bilateral vocal fold paralysis in the adducted position. After failed extubation attempts, tracheostomy was required. The patient improved with optimized MG management and was discharged after three weeks. This rare MG manifestation emphasizes the importance of early stridor recognition, difficult airway preparedness, and adherence to American Society of Anesthesiologists guidelines for airway management and bronchoscopy.