Anesthetic Management for a Patient with Inclusion Body Myositis

Nakano, Noriyuki; Satsumae, Tsuyoshi; Mizutani, Taro; Kimura, Maiko; Tokuwaka, Junko; Tanaka, Makoto

doi:10.2199/jjsca.32.809

Cited by 4 publications

(7 citation statements)

References 4 publications

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“…Indeed, the authors were unable to extubate their patient after reversal of neuromuscular blockade, most likely because of underlying pulmonary dysfunction related to IBM. Similar to the authors’ approach in the current patient, Nakano et al described endotracheal intubation without the use of a neuromuscular blocker after induction of general anesthesia in an elderly man with IBM undergoing a jejunostomy, but this patient developed postoperative aspiration pneumonia ( 22 ). The current patient did not have a history of compromised pulmonary function and was easily extubated after surgery.…”

Section: Discussionmentioning

confidence: 72%

Anesthetic Considerations of Sporadic Inclusion Body Myositis in an Elderly Man With Orthopedic Trauma

et al. 2016

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IntroductionSporadic inclusion body myositis (IBM) is an inflammatory myopathy characterized by progressive asymmetric extremity weakness, oropharyngeal dysphagia, and the potential for exaggerated sensitivity to neuromuscular blockers and respiratory compromise. The authors describe their management of a patient with IBM undergoing urgent orthopedic surgery.Case PresentationAn 81-year-old man with IBM suffered a left intertrochanteric femoral fracture after falling down stairs. His IBM caused progressive left proximal lower extremity, bilateral distal upper extremity weakness (left > right), and oropharyngeal dysphagia (solid food, pills). He denied dyspnea, exercise intolerance, and a history of aspiration. Because respiratory insufficiency resulting from diaphragmatic dysfunction and prolonged duration of action of neuromuscular blockers may occur in IBM, the authors avoided using a neuromuscular blocker. After applying cricoid pressure, anesthesia was induced using intravenous lidocaine, propofol, remifentanil followed by manual ventilation with inhaled sevoflurane in oxygen. Endotracheal intubation was accomplished without difficulty; anesthesia was then maintained using remifentanil and sevoflurane. The fracture was repaired with a trochanteric femoral nail. The patient was extubated without difficulty and made an uneventful recovery.ConclusionsIn summary, there is a lack of consensus about the use of neuromuscular blockers in patients with IBM. The authors avoided these drugs and were able to easily secure the patient’s airway and maintain adequate muscle relaxation using a balanced sevoflurane-remifentanil anesthetic. Clinical trials are necessary to define the pharmacology of neuromuscular blockers in patients with IBM and determine whether use of these drugs contributes to postoperative respiratory insufficiency in these vulnerable patients.

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Section: Discussionmentioning

confidence: 72%

Anesthetic Considerations of Sporadic Inclusion Body Myositis in an Elderly Man With Orthopedic Trauma

et al. 2016

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“…The causes of death among the patients were related to their severe comorbidities and unlikely to be related to an aspect of anesthetic management. A systematic review of the literature identified 5 reports [10,[15][16][17][18] describing anesthetic management for patients with IBM (Table 3). …”

Section: Resultsmentioning

confidence: 99%

“…Little information has been published about anesthetic management for patients with IBM, and our systematic literature review identified a few case reports (Table 3) [10, [15][16][17][18]. Briefly, 1 patient underwent video-assisted thoracoscopy for pneumothorax under general anesthesia with rocuronium, which was reversed with neostigmine, but the patient remained intubated postoperatively despite an absence of residual neuromuscular blockade or muscle weakness [10].…”

Section: Discussionmentioning

confidence: 99%

“…The third report featured a 76-year-old man with dysphagia who underwent jejunostomy under general anesthesia. The patient was intubated without muscle relaxants, but on postoperative day 2, aspiration pneumonia developed [17]. Another patient with IBM and bilateral lower extremity weakness underwent an uneventful outpatient metacarpophalangeal fusion under infraclavicular nerve block and general inhalational anesthesia through a laryngeal mask airway [15].…”

Section: Discussionmentioning

confidence: 99%

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Inclusion body myositis and anesthesia: a case series

Mortenson

Šprung

Cavalcante

et al. 2016

Journal of Clinical Anesthesia

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“…Consequently, the risk of postoperative pulmonary complications including aspiration pneumonia could increase. Indeed, Nakano and colleagues reported postoperative aspiration of a patient with IBM [5]. In this case, the patient was managed without muscle relaxation but developed aspiration pneumonia on the second postoperative day, which was successfully treated with antibiotics.…”

Section: Discussionmentioning

confidence: 95%

Anesthetic management of a hydrocephalus patient with inclusion body myositis

et al. 2017

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Inclusion body myositis (IBM) is an inflammatory muscle disease characterized by slowly progressive muscle weakness and wasting, especially affecting proximal leg and distal arm. We report a successful anesthetic management of a 68-year-old male patient with IBM undergoing ventriculoperitoneal shunt. Anesthesia was induced and maintained with total intravenous anesthesia using propofol, remifentanil, and ketamine. The trachea was uneventfully intubated without muscle relaxants. Ultrasound-guided subcostal transversus abdominis plane block and rectus sheath block were performed with 0.25% levobupivacaine 45 ml that could provide good surgical condition without muscle relaxants. Intravenous flurbiprofen 50 mg and morphine 2 mg were used for postoperative analgesia. The patient's emergence from general anesthesia and the postoperative course was uneventful.

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Anesthetic Management for a Patient with Inclusion Body Myositis

Cited by 4 publications

References 4 publications

Anesthetic Considerations of Sporadic Inclusion Body Myositis in an Elderly Man With Orthopedic Trauma

Anesthetic Considerations of Sporadic Inclusion Body Myositis in an Elderly Man With Orthopedic Trauma

Inclusion body myositis and anesthesia: a case series

Anesthetic management of a hydrocephalus patient with inclusion body myositis

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