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Background and Aims Huntington’s disease (HD) is a rare and progressive neurodegenerative disorder characterized by motor dysfunction, cognitive decline, and psychiatric symptoms. There are a limited number of case reports published describing the anesthetic management of patients with HD, which presents unique challenges. This case report describes the management of a patient on the severe stage of HD, who underwent general anesthesia combined with peripheral nerve blocks for the placement of percutaneous endoscopic gastrostomy (PEG) tube.

Methods A 55-year-old female, ASA III, with a known diagnosis of HD presented for the placement of a PEG tube. The preoperative history and physical examination showed a total dependent patient with severe choreiform movements in the extremities, cognitive impairment and a significant decline in nutritional status due to the severe dysphagia. After routine ASA monitoring, induction of anesthesia was performed. Anesthesia was maintained using a target-controlled infusion of propofol. Following the induction of general anesthesia, a bilateral rectus sheath block (RSB) under ultrasound guidance was performed with 10mL of ropivacaine 0.5% on each side.

Results Throughout the 60-min duration of surgery and anesthetic procedure, the patient maintained hemodynamic stability. The patient was monitored in the postoperative care unit and showed no complications and did not require additional analgesia.

Conclusions This case highlights the importance of a tailored anesthetic approach in patients with HD undergoing surgical procedures. The use of general anesthesia in combination with peripheral nerve blocks can provide effective anesthesia and analgesia while minimizing the risk of adverse outcomes.