Remifentanil in a patient with Huntington's chorea - case report

Abstract

Relatively few published case reports related to the anaesthetic management of Huntington's chorea (HC) exist. At the time of surgery no publications were found related to remifentanil's use in patients with HC. This case report describes the management of a confirmed HC patient requiring urgent decompression of a spinal tumour associated with quadriparesis. A fibre-optic (FO) assisted naso-tracheal intubation was performed under mild sedation with midazolam and fentanyl. Prior nebulization with lignocaine and further supplementary topical application provided local anaesthesia to the airway. Following intubation the patient was assessed neurologically prior to induction with propofol 100 mg and rocuronium 30 mg. Isoflurane 0,5% to 0,75% and remifenanil, initially infused at the rate of 0,25µg kg^-1 min^-1 rapidly reduced to between 0,04-0,08µg kg^-1 min^-1, provided intraoperative anaesthesia and analgesia for the three hour procedure. A Bair Hugger warming device was used to guard against the risk of hypothermia and subsequent postoperative shivering known to precipitate life threatening generalized spasms in HC patients. The surgery and anaesthesia had a favourable outcome. Rapid recovery after the termination of the remifentanil and the absence of any untoward intraoperative events related to its use demonstrate that remifentanil may be a valuable adjunct for providing intraoperative analgesia in patients with HC.

Keywords: genetic factors, anaesthesia, surgery, spinal, remifentanil

Southern African Journal of Anaesthesia and Analgesia Vol. 12(1) 2006: 17-19