Videolaryngoscope-guided intubation without neuromuscular blockade in a patient with Huntington’s disease

Abstract

Huntington’s disease (HD) has a risk of potential perioperative complications such as aspiration, drug interactions with anesthetics, agitation, psychosis, shivering, and spasms. Thus, inexperienced anesthesiologists may face challenges in the management of HD patients. A 54-year-old man with HD was scheduled to undergo open reduction and internal fixation of an intertro-chanteric femur fracture. We successfully performed videolaryngoscope-guided intubation after propofol sedation and oral topical anesthesia, as awake fibreoptic bronchoscopy-guided intubation had failed because of noncooperation and choreiform movements. Total intravenous anesthesia was maintained with propofol and remifentanil infusion, and intraoperative neuromuscular block was controlled with rocuronium and sugammadex successfully, without any postoperative complications. His psychotropic medications were restarted from the morning of postoperative day 1. Videolaryngoscope-guided intubation, total intravenous anesthesia, use of rocuronium and sugammadex, and re-administration of psychotropic medication as soon as possible form one of the successful regimens for HD patients.