Inclusion body myositis and anesthesia: a case series

Mortenson, Andrew R.; Šprung, Juraj; Cavalcante, Alexandre N.; Watson, James C.; Weingarten, Toby N.

doi:10.1016/j.jclinane.2016.02.018

Cited by 7 publications

(14 citation statements)

References 14 publications

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“…Other studies were on the anesthetic management of patients with myotonic dystrophy type I (DMI) 29 , 30 and II, 31 , 32 amyotrophic lateral sclerosis, 33 – 35 Duchenne muscular dystrophy, 36 glycogen storage disease, 37 inclusion body myositis, 38 Lambert–Eaton myasthenic syndrome, 39 mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes mitochondrial encephalomyopathy 40 and OPMD. 41 Opioid use was possibly associated with postoperative complications in a small retrospective study on the anesthetic management of DMI.…”

Section: Resultsmentioning

confidence: 99%

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Bersselaar

Gubbels

Riazi

et al. 2022

Can J Anesth/J Can Anesth

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Purpose Patients with neuromuscular disorders (NMDs) are at increased risk of perioperative complications. The objective of this scoping review was to examine emerging evidence from published studies, case reports, and review articles on anesthetic management of patients with NMDs, following the methodological frame for scoping reviews. Sources We searched PubMed and EMBASE for articles published between 1 January 2000 and 14 July 2021. Principal findings Three prospective and 21 retrospective studies on altered pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBA) in NMD patients were included. Furthermore, 168 case reports/series reporting 212 anesthetics in 197 patients were included. These studies showed that preanesthetic neuromuscular monitoring can be used for precise NMBA dosing in myasthenia gravis patients. Sugammadex was associated with fewer postoperative myasthenic crises. Perioperative complications were not associated with specific anesthetic agents. Case reports/series showed that in 32% (67/212) of anesthetics, at least one complication was reported. Unexpected intensive care unit admission was a frequently reported complication. Patients with a complicated disease course may have had a higher use of succinylcholine (unadjusted relative risk, 0.13; 95% confidence interval [CI], 0.20 to 0.86) and volatile anesthetics (adjusted odds ratio [OR], 0.38; 95% CI, 0.20 to 0.73; P = 0.004). Conclusion Evidence on the anesthetic management and perioperative complications of patients with NMDs is mainly based on small retrospective studies and case reports. Further clinical trials or large retrospective studies are required to investigate the choice of safe anesthetic agents. Main areas of interest are the potential benefits of neuromuscular monitoring and sugammadex and the risks possibly associated with volatile anesthetics and succinylcholine. Supplementary Information The online version of this article contains supplementary material available 10.1007/s12630-022-02230-3.

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Section: Resultsmentioning

confidence: 99%

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Bersselaar

Gubbels

Riazi

et al. 2022

Can J Anesth/J Can Anesth

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“…In the perioperative period for these patients there is concern for anesthetic-induced respiratory failure leading to prolonged or permanent ventilator needs, demonstrating the importance of reduced operative time and minimizing the potential for revision surgery. 10 In our series, all 41 patients were extubated and returned to their baseline respiratory status prior to discharge. There was a statistically significant difference in follow-up time between those that had recurrence and those that did not, which is likely a reflection of our follow up patterns; patients that had recurrences returned to clinic to seek out reevaluation where as those without recurrence did not have as long of a follow-up at our institution.…”

Section: Discussionmentioning

confidence: 97%

Cricopharyngeal Myotomy in Inclusion Body Myositis: Comparison of Endoscopic and Transcervical Approaches

et al. 2021

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Objective: Inclusion body myositis (IBM) is a progressive inflammatory myopathy with dysphagia as a debilitating sequalae. Otolaryngologists are consulted for surgical candidacy when there are findings of cricopharyngeal dysfunction. We aim to compare transcervical cricopharyngeal myotomy (TCPM) versus endoscopic cricopharyngeal myotomy (ECPM) in the IBM population with particular focus on objective swallow study outcomes, complications, and recurrence rates.Methods: A retrospective cohort study was performed on IBM patients who underwent TCPM or ECPM in the Department of Otolaryngology at a tertiary academic center with a high volume IBM referral base. Videofluoroscopic swallow studies, Eating Assessment Tool (EAT-10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and follow-up visits. Baseline patient characteristics, intraoperative data, and postoperative course were recorded.Results: Forty-one patients were identified (18 TCPM; 23 ECPM). There was no significant difference in the recurrence rates, complications, hospitalization length, operative time, or return to preoperative diet between approaches. For the 12 patients (11 ECPM; 1 TCPM) that had subjective swallow data, there was a statistically significant difference in the pre and postoperative scores for EAT-10, RSI, and FOSS (P < .05). There was a statistically significant improvement in the degree of narrowing between pre and postoperative imaging for both approaches (P < .05).Conclusion: Both TCPM and ECPM are safe approaches for the management of dysphagia in patients with IBM with objective evidence of cricopharyngeal dysfunction. Cricopharyngeal myotomy is a durable technique that has demonstrated improved subjective and objective outcomes in this patient population.

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“…Thus, we chose TIVA because IBM is categorized as an inflammatory myopathy. However, as Mortenson and colleagues [2] reported case series of anesthesia for IBM patients showing no adverse reactions with inhalational anesthesia, both anesthetic methods might be acceptable for IBM patients.…”

Section: Discussionmentioning

confidence: 99%

“…As the sensitivity of IBM patients to muscle relaxants has not been elucidated, we avoided to use muscle relaxant in the present case. However, Mortenson and colleagues reported [2] that muscle relaxant was safely used for 16 IBM patients including 8 patients revealing dysphagia, and the postoperative course was unremarkable in all patients except patients planning postoperative mechanical ventilation. Thus, muscle relaxants might safely be used for the IBM patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, dysphagia often occurs and increases the risk of aspiration [1]. Because of the rarity, there are not many case reports regarding anesthetic management of patients with IBM, and the anesthetic management has yet to be established [2]. Thus, we report a case of successful anesthetic management in a patient with IBM undergoing ventriculoperitoneal shunt.…”

Section: Introductionmentioning

confidence: 95%

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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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Inclusion body myositis and anesthesia: a case series

Cited by 7 publications

References 14 publications

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Cricopharyngeal Myotomy in Inclusion Body Myositis: Comparison of Endoscopic and Transcervical Approaches

Anesthetic management of a hydrocephalus patient with inclusion body myositis

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