Role of noninvasive ventilation in perioperative patients with neuromuscular disease: a clinical case

Marinho, Ana Sofia; Guimarães, Mario José; Lages, N.; Correia, Carlos

doi:10.1016/j.bjane.2013.06.021

Cited by 2 publications

(4 citation statements)

References 4 publications

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“…Some published articles report the use of reduced doses or avoidance of muscle relaxants in patients with IBM because of the possibility of exaggerated sensitivity to these drugs and prolonged duration of action in inflammatory myopathies including IBM. 7 , 8 , 13 , 14 However, there are no conclusive data regarding the pharmacokinetics, pharmacodynamics, and safety of neuromuscular blockers in IBM. In fact, the case series by Mortenson et al reported 16 patients with IBM who underwent surgery and received either depolarizing or nondepolarizing agents.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia Spearheading Perioperative Safety Efforts in a Patient with Inclusion Body Myositis: A Case Report

Aspi, MD,

Arancon, MD, MBA

2024

Acta Med Philipp

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Anesthesiologists have been at the forefront of initiatives addressing perioperative patient safety. As anesthesia has no direct therapeutic benefit, its risk must be minimized. At times the surgery is simple but the patient’s condition complicates anesthetic management, increasing the risk for complications. This report describes the anesthetic management of an adult patient diagnosed with inclusion body myositis (IBM), a rare inflammatory degenerative myopathy, who initially presented with decreased motor function in both lower and upper extremities causing him to be bedbound for two years. Due to the progression of his disease, he eventually developed dysphagia, hence he was scheduled for esophagoscopy, cricopharyngeal Botox injection, and percutaneous endoscopic gastrostomy. As patients with IBM are at risk for exaggerated sensitivity to neuromuscular blockers and respiratory compromise, anesthesia was at the helm of a multidisciplinary team approach. The perioperative management centered on preoperative optimization, prevention of aspiration, avoidance of anesthetics that may trigger malignant hyperthermia, and prevention of postoperative pulmonary complication. The hospital course was uncomplicated and the patient was discharged well after one day. This report emphasizes how improvements in resources, technology, and healthcare delivery, especially in anesthesia, help prevent perioperative adverse events.

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Section: Discussionmentioning

confidence: 99%

Anesthesia Spearheading Perioperative Safety Efforts in a Patient with Inclusion Body Myositis: A Case Report

Aspi, MD,

Arancon, MD, MBA

2024

Acta Med Philipp

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“…Indeed, he did not develop aspiration pneumonia after surgery. Marinho et al reported a unique approach to anesthesia in a patient with IBM who underwent percutaneous thoracic vertebral kyphoplasty in prone position ( 23 ). This patient required chronic non-invasive ventilation because of poor respiratory function.…”

Section: Discussionmentioning

confidence: 99%

“…The patient’s intraoperative care was managed using epidural anesthesia, conscious sedation, and bi-level positive airway pressure. In this case, the authors ( 23 ) avoided endotracheal intubation entirely because they were concerned that the patient’s preexisting respiratory dysfunction may preclude their ability to wean the patient from mechanical ventilation after the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The current and previous ( 20 - 23 ) cases used reduced doses of or completely avoided neuromuscular blockers in patients with IBM because of theoretically enhanced sensitivity to these drugs, but with the exception of anecdotal experience, there are no data to definitively establish the pharmacokinetics, pharmacodynamics, and relative safety of neuromuscular blockers in this setting. The actions of neuromuscular blockers may be prolonged in other forms of inflammatory myopathy, but this contention has not been examined systematically in controlled clinical trials and remains controversial, in part because inflammatory myopathies including IBM may not affect the functional integrity of the neuromuscular junction ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

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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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Role of noninvasive ventilation in perioperative patients with neuromuscular disease: a clinical case

Cited by 2 publications

References 4 publications

Anesthesia Spearheading Perioperative Safety Efforts in a Patient with Inclusion Body Myositis: A Case Report

Anesthesia Spearheading Perioperative Safety Efforts in a Patient with Inclusion Body Myositis: A Case Report

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

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