Anaesthetic Management of a Patient with Dermatomyositis and Valvular Heart Disease

Abstract

Dermatomyositis is an idiopathic inflammatory myopathy with involvement of muscle, skin and other organs. Valvular heart disease increases the risk of perioperative adverse cardiac events. Only a little information is available about the anaesthetic management of a patient with dermatomyositis and valvular heart disease. Here we considered combined spinal-epidural technique for total abdominal hysterectomy, minimizing the risk of delayed recovery from muscle relaxants, aspiration pneumonitis, arrhythmias and cardiac failure.

Manejo anestésico de paciente con dermatomiositis paraneoplásica en cirugía de cáncer de ovario

“…Los relajantes musculares por lo tanto, pueden tardar más en alcanzar la unión neuromuscular, lo que da lugar a un inicio de acción más lento y un período de reversión más largo [1], [4]. No hay que olvidar que muchos de estos pacientes presentan patologías malignas que por sí mismas ya afectan a la transmisión neuromuscular [3], [5].…”

“…El empleo de los reversores de los relajantes es controvertido. Algunos autores describen que pueden causar mayor debilidad muscular y disritmias [5].…”

“…El manejo anestésico requiere una especial atención debido a la aparición de disfunción pulmonar por la debilidad de los músculos torácicos, enfermedad pulmonar intersticial, neumonitis secundaria a fármacos o alteraciones cardíacas, junto al riesgo de crisis miotónicas, hiperpotasémicas, hipertermia maligna o rabdomiolisis [5].…”

Anaesthetic Management of Patients with Takayasu’s Arteritis for Open Cholecystectomy: a Report of Two Cases

“…17 Further, Shrestha GS et al have reported a case describing the safety and efficacy of combined epidural spinal in a patient of dermatomysitis with valvular heart disease undergoing total abdominal hysterectomy. 18 There may be other problems complicating the anaesthetic management. Cardiac dysfunction, if present is mainly because of hypertension.…”

Anesthetic management of a pregnant female posted for caesarean section with biopsy proven polymyositis

“…These patients are supposed to be sensitive to nondepolarizing muscle relaxants, and use of their antagonist drugs may cause muscle weakness and dysrhyhmias. [ 2 ] Vecuronium and pancuronium are associated with prolonged neuromuscular paralysis though atracurium has been implemented as a safe drug under neuromuscular monitoring. Neuromuscular monitoring is suggested in these patients due to lack of standard recommendations regarding to the application of nondepolarizing muscle relaxants.…”