Anesthetic Management of a Patient with Type II Alexander Disease: A Case Report

Patients with type II Alexander disease have white matter dysplasia, which may cause various symptoms due to nerve conduction impairment. When providing anesthesia to a patient with Alexander disease, careful and patient-specific individualized risk evaluation must be preceded by planning the method of anesthesia and anesthetic drugs. This is the first case report of a patient with type II Alexander disease who underwent general anesthesia. We performed general anesthesia on a 45-year-old male with type II Alexander disease for laparoscopic cholecystectomy, using remimazolam, remifentanil, and rocuronium. Despite the use of reversal agents including flumazenil, naloxone, and sugammadex, the patient manifested a delay in emergence but successfully recovered from anesthesia without postoperative complications. In consideration of the possibility that leukodystrophy may have altered responses to anesthetics, the action of an anesthetic agent may be prolonged or delayed in patients with type II Alexander disease. We recommend using drugs with a short duration of action and which can be reversed immediately by a reversal agent.