• Hoon Jung, Hyunjee Kim, and See Woo Lee.
• Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
• Medicine (Baltimore). 2023 Nov 17; 102 (46): e36174e36174.

RationaleNemaline myopathy (NM) is a congenital disease characterized by nonprogressive or slowly progressing muscle weakness and may increase the risk of anesthesia in case of respiratory muscle or cardiac involvement. Care should be taken to prevent respiratory failure after surgery.Patient ConcernsA 35-year-old man with NM, who had difficult airway, restrictive ventilatory pattern, and pulmonary hypertension, required general anesthesia for surgery because of limited mouth opening.DiagnosesThe patient was diagnosed with NM (ACTA1 mutation) and coronoid hyperplasia.InterventionsAwake fiberoptic nasal intubation was performed following preparations for analgesia. General anesthesia was maintained using inhalational anesthetics and opioids without using neuromuscular blocking agents.OutcomesGeneral anesthesia remained well maintained during surgery, with no movement or spontaneous breathing of the patient and he recovered from anesthesia uneventfully without complications.LessonsThis report highlights the safe performance of anesthesia induction and recovery in a case where anesthesia management is necessary for surgery in a patient of NM at a high risk of anesthesia-related complications.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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