Nguyen Phuong Thao, Meeks Daveena, Liotiri Despoina
Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
BMJ Case Rep. 2017 Oct 19;2017:bcr-2017-221354. doi: 10.1136/bcr-2017-221354.
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.
我们报告了一例病例，该病例突出了为患有亨廷顿舞蹈症（HD）和延髓功能障碍的患者实施安全全身麻醉时所涉及的问题。对于一名接受腹腔镜经皮内镜胃造口管插入术的46岁患者，我们讨论了所选方法和麻醉药物背后的原理，以及HD特有的气道问题。对于一名病情不允许清醒纤维支气管镜插管的患者，我们选择了改良快速顺序诱导法。鉴于HD患者存在因肌肉松弛不足和肌松药逆转引起的并发症，我们在肌肉松弛方面进行了特殊考虑。我们所描述的技术也可能适用于其他患者群体，如患有运动障碍、延髓功能障碍和痴呆症的患者。
