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Rare disease
CASE REPORT
Anaesthesia and orphan disease: airway and anaesthetic management in Huntington’s disease
  1. Phuong Thao Nguyen,
  2. Daveena Meeks,
  3. Despoina Liotiri
  1. Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Phuong Thao Nguyen, phuongthao.nguyen{at}bsuh.nhs.uk

Summary

We present a case that highlights the issues surrounding the delivery of a safe general anaesthetic to a patient with Huntington’s disease (HD) and bulbar dysfunction. In the case of a 46-year-old patient undergoing laparoscopic percutaneous endoscopic gastrostomy tube insertion, we discuss the rationale behind our chosen method and anaesthetic agents as well as airway issues specific to HD. In a patient whose condition would not allow for an awake fibreoptic intubation, we opted for a modified rapid sequence induction. Special considerations were made with regard to muscle relaxation given the complications associated with inadequate paralysis and reversal in patients with HD. The technique we describe may also apply to other patient categories, such as patients with movement disorders, bulbar dysfunction and dementia.

  • anaesthesia
  • movement disorders (other than parkinsons)

https://doi.org/10.1136/bcr-2017-221354

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    Footnotes

    • Contributors All authors meet the authorship criteria and certify that they have made substantial contribution to the conception, design, acquisition, analysis and interpretation of data related to this case report; drafting the work and revising it critically for important intellectual content and final approval of the version to be published. Conception and design of case report: PTN, DM and DL. Acquisition of data: PTN and DL. Analysis and interpretation of data: PTN, DM and DL. Drafting the manuscript: PTN, DM and DL. Revising the manuscript critically for important intellectual content: PTN, DM and DL. Approval of the version of the manuscript to be published: PTN, DM and DL. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors will take public responsibility for the contents.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.