Motor neuron disease (MND) typically affects upper and lower motor neurons without any sensory involvement. Regional anaesthesia is preferred in motor neuron disease patients to avoid aspiration and possibility of prolonged postoperative ventilation following general anaesthesia. As microlaryngeal surgery in a motor neuron disease patient needed airway protection, it was decided to perform the surgery under general anaesthesia with awake intubation following airway block and avoiding muscle relaxant agents completely to minimise unnecessary complications. The patient was allowed spontaneous breathing while maintaining anaesthesia and stable haemodynamic condition with combination of anaesthetic and analgesic agents accordingly throughout the operation.