Anesthetic management of a patient with progressive supranuclear palsy

A 74-year-old woman with progressive supranuclear palsy (PSP) was scheduled for laryngotracheal separation surgery. Her neck showed severe backward tilt as a symptom of PSP. Magnetic resonance imaging (MRI) showed a significant airway stenosis due to the neck deformity. In the operating room, awake orotracheal intubation failed because of the neck deformity and airway stenosis. Therefore, tracheotomy was performed for airway management. General anesthesia was induced and maintained with sevoflurane (1.0%-2.5%) and fentanyl (total, 200 microg). Vecuronium (total, 5 mg) was used as a muscle relaxant. Monitoring of the train-of--four ratio in the ulnar nerve was impossible because of contracture of the fingers. Patients with PSP may have some serious associated deformities, and specific management, especially for the airway, may be necessary for general anesthesia.