Anesthetic Management and Perioperative Outcome of Emergency Laparotomy in a Patient With Advanced Motor Neurone Disease: A Case Report

ABSTRACT Motor neurone disease (MND) presents significant perioperative challenges due to progressive respiratory muscle weakness, bulbar dysfunction, autonomic instability, and altered sensitivity to anesthetic agents. Emergency surgery further limits opportunities for optimisation and advance planning. We report the perioperative and anesthetic management of a patient with advanced MND undergoing emergency laparotomy for small bowel obstruction. A total intravenous anesthetic with cautious use of neuromuscular blockade was employed, and the patient was successfully extubated postoperatively. Despite an initially uncomplicated postoperative course, the patient subsequently developed progressive respiratory failure in the context of ongoing intra‐abdominal pathology. Following multidisciplinary discussion and shared decision‐making, care was transitioned to a comfort‐focused approach. This case highlights the limitations of perioperative intervention in advanced MND and emphasizes the importance of goal‐concordant care in emergency surgical settings.