anesthetic considerations of sporadic inclusion body myositis in an elderly man with orthopedic trauma
نویسندگان
چکیده
conclusions in 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. introduction sporadic 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 presentation an 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.
منابع مشابه
Anesthetic Considerations of Sporadic Inclusion Body Myositis in an Elderly Man With Orthopedic Trauma.
INTRODUCTION Sporadic 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 PRESENTATION An 81-year-old...
متن کاملSporadic inclusion body myositis: an unsolved mystery.
Sporadic inclusion body myositis (sIBM) is considered to be the most common acquired muscle disease associated with aging. It is a disabling disorder still without effective treatment. sIBM causes weakness and atrophy of the distal and proximal muscles. Involvement of quadriceps and deep finger flexors are clues to early diagnosis. Dysphagia in the course of the disease is common. Muscle biopsy...
متن کاملOngoing Developments in Sporadic Inclusion Body Myositis
Sporadic inclusion body myositis (IBM) is an acquired muscle disorder associated with ageing, for which there is no effective treatment. Ongoing developments include: genetic studies that may provide insights regarding the pathogenesis of IBM, improved histopathological markers, the description of a new IBM autoantibody, scrutiny of the diagnostic utility of clinical features and biomarkers, th...
متن کاملSporadic inclusion body myositis: a continuing puzzle.
There is now compelling evidence that sporadic inclusion body myositis (sIBM) is a muscle-specific autoimmune disease in which both T and B-cells play a part and in which both cytotoxic muscle fibre necrosis and degeneration occur. However the factors responsible for breakdown of immune tolerance and the nature of the target antigens expressed by muscle fibres remain unknown. Genetic factors ar...
متن کاملBalloon Dilation in Sporadic Inclusion Body Myositis Patients with Dysphagia
Here, we describe balloon catheter dilation at the upper esophageal sphincter (UES) in three sporadic inclusion body myositis (s-IBM) patients with dysphagia. Initially, we performed IVIg therapy, and, three months later, switched to balloon dilation therapy. A 12-Fr balloon catheter was inserted from the mouth under fluoroscopy and the balloon inflated at the UES. The catheter was pulled back ...
متن کاملمنابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
anesthesiology and pain medicineجلد ۶، شماره ۲، صفحات ۰-۰
میزبانی شده توسط پلتفرم ابری doprax.com
copyright © 2015-2023