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Difficult intubation of a patient with progressive multifocal leukoencephalopathy and muscle spasticity - A case report -
Anesth Pain Med 2018;13(2):149-53
Published online April 30, 2018
© 2018 The Korean Society of Anesthesiologists.

Ji-Eun Kim , Young-Kwon Yang, Mi-Young Kwon, Mi-jung Yun, and Gunn-Hee Kim
Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
Correspondence to: Ji-Eun Kim, M.D.
Department of Anesthesiology and Pain Medicine, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 04564, Korea
Tel: 82-2-2260-7114
Fax: 82-2-2267-8685
Received September 14, 2017; Revised October 17, 2017; Accepted October 18, 2017.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Progressive multifocal leukoencephalopathy (PML) is a demyelinating central nervous system disease characterized by neurological deficits, including cognitive impairment, altered mental status, and muscle spasticity. Preoperative evaluation and intraoperative airway management of the airway is difficult in patients with this disease. In this report, the authors describe a 62-year-old man with PML and spastic hemiparesis, who was scheduled for video-assisted thoracic bullectomy under general anesthesia. A preoperative airway evaluation, including Mallampati classification, could not be performed due to lack of patient cooperation. Additionally, the anesthesiologist did not perform diverse physical assessments of the airway or prepare an adequate airway management strategy. During induction of general anesthesia, difficulty with intubation was encountered because of limited mouth opening. This case emphasizes that anesthesiologists should have thorough knowledge of airway assessment and management strategies, and perform a comprehensive assessment to implement appropriate airway management in patients with this disease.
Key Words : Intubation, Muscle spasticity, Progressive multifocal leukoencephalopathy.

April 2018, 13 (2)
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