Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 06 08 1600 1600 Philip Benito Astorga Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Manila City, Philippines. Patricia Lorna Cruz Department of Anesthesiology, Philippine General Hospital, Faculty of Medicine, University of the Philippines, Manila City, Philippines. 2026 02 28 2026 03 30 Thyroplasty, the treatment for vocal fold paralysis, is usually managed under local anesthesia with sedation. This poses difficulties for the surgical team, as inadequate suppression of laryngeal reflexes may lead to coughing and laryngeal movement. A rapid offset of sedation is also critical to allow for intraoperative voice assessment and pitch adjustment. This paper describes an anesthetic approach using total intravenous anesthesia with a combination of remifentanil and dexmedetomidine for a patient undergoing the procedure. The elderly patient was able to remain immobile and relaxed with good spontaneous respiration during surgical dissection and was able to emerge and phonate appropriately during voice monitoring. The technique provided a quiet surgical field and improved patient comfort. https://aacc.tums.ac.ir/index.php/aacc/article/view/1600