General anaesthesia for laparoscopic cholecystectomy in a patient with ataxia with oculomotor apraxia type 2

Ataxia with oculomotor apraxia type 2 is a rare autosomal recessive cerebellar ataxia caused by senataxin gene mutations, with minimal published data on anaesthetic management. We report the peri-operative care of a 46-year-old woman with genetically confirmed ataxia with oculomotor apraxia type 2 undergoing laparoscopic cholecystectomy under general anaesthesia. Key challenges included uncertain sensitivity to neuromuscular blocking agents and the potential for respiratory weakness and bulbar dysfunction. Non-technical challenges arose from incomplete recognition and communication of the condition pre-operatively. Anaesthetic strategy prioritised titratable, reversible agents and careful intra-operative monitoring. Rocuronium was administered in reduced dose with quantitative neuromuscular monitoring and fully reversed with sugammadex prior to tracheal extubation. Propofol, sevoflurane and remifentanil target-controlled infusion were used to ensure haemodynamic stability and minimise cumulative opioid exposure. The patient recovered uneventfully with no residual weakness or respiratory impairment. To our knowledge, this is the first published description of general anaesthesia for laparoscopic surgery in a patient with ataxia with oculomotor apraxia type 2. It demonstrates that anaesthesia can be safely delivered to patients with this condition with careful pre-operative planning.