Because of unpredictable and potentially
difficult airway management, a spontaneous ventilation technique is
recommended (however, because of choreoathetoid movements and muscle
rigidity, neuromuscular blockade may often be needed, thus requiring
tracheal intubation with assisted face-mask ventilation).
However, before administration of neuromuscular blocking agents, ensure
that lung ventilation can be supported by face-mask ventilation.
With deepening of
anesthesia, the torticollis, scoliosis, and oromandibular muscular rigidity
disappear. However, following a long course of dystonic attacks and muscle
rigidity, musculoskeletal deformations become fixed. Usual treatment should
not be discontinued and should be resumed during the immediate postoperative
period through a nasogastric tube. Signs of basal ganglias dysfunction
(chorea, athetosis, and rigidity) reappear on emergence. Aspiration
pneumonitis occurs easily. In the most severe situation, maintenance of
postoperative mechanical ventilation might be indicated for better pain