# Anesthetic management in the lateral position in a patient with Parkinson’s disease who developed severe long-seated forward flexion with the face buried between the knees: a case report

## TL;DR

This case report describes successful anesthetic management in a Parkinson's patient with severe spinal flexion using a lateral position and specific techniques.

## Contribution

The paper demonstrates a novel approach to airway management and anesthesia in Parkinson’s patients with extreme spinal deformity.

## Key findings

- Anesthesia administered in the lateral position was feasible for a Parkinson’s patient with severe spinal flexion.
- Video laryngoscopy enabled successful intubation in this challenging case.
- Remimazolam with flumazenil provided good recovery without complications.

## Abstract

Camptocormia, a postural deformity seen in Parkinson’s disease (PD), complicates general anesthesia, especially airway management, owing to severe spinal flexion in advanced stages.

We report the anesthetic management of a 76-year-old man with PD who developed severe long-seated forward flexion with the face buried between the knees, from camptocormia and multiple spinal surgeries. Removal of the exposed spinal implants was necessary, and general anesthesia was planned. Anesthesia was administered in the right lateral position from induction to awakening. Video laryngoscopy enabled successful intubation, and remimazolam with flumazenil ensured good recovery without complications.

This case demonstrates the feasibility of managing the airway and administering anesthesia in the right lateral position in patients with PD with severe long-seated forward flexion. Video-laryngoscopy and remimazolam with flumazenil offer advantages in such cases, although further studies are required to validate their broader applications.