Anesthetic management of a patient with myotonic dystrophy for laparoscopic cholecystectomy--a case report (original) (raw)
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Anesthesia for a Patient with Myotonic Dystrophy
Haseki Tıp Bülteni, 2016
Myotonic dystrophy is the most common myotonic syndrome causing abnormalities of the skeletal and smooth muscles as well as problems related to the cardiac, gastrointestinal and endocrine systems. In affected people, reduced functional residual capacity, vital capacity, and peak inspiratory pressure are observed within the respiratory system. As would be expected, anesthetic management of these patients is challenging for anesthesiologists. In addition, delayed recovery from anesthesia and cardiac and pulmonary complications may develop in the intraoperative and early postoperative periods due to sensitivity to sedatives, anesthetic agents, and neuromuscular blocking agents. Myotonic dystrophy can be performed with the use of appropriate anesthesia procedures as well as carefully communication between anesthesiologists and surgeons. In conclusion, myotonic dystrophy has variations, which makes it important to preoperatively determine specific surgical and anesthetic management strategies for each patient. In this article, we present a patient with myotonic dystrophy who underwent laparoscopic cholecystectomy surgery for symptomatic cholelithiasis and to discuss the relevant literature.
Anesthesia and myotonic dystrophy type 2: a case series
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2010
Background Myotonic dystrophy type 2 (DM2) is a genetically distinct disorder that shares some phenotypical features of myotonic dystrophy type 1 (DM1). However, anesthetic management of patients with DM2 has not been described. The purpose of this study is to report the anesthetic management of a series of patients with DM2 and to describe their response to anesthesia. Methods We performed a computerized search of the Mayo Clinic medical records database looking for patients with DM2 who underwent general anesthesia. The medical records were reviewed for anesthetic technique, medications used, and postoperative complications. Results We identified 19 patients with DM2 who underwent 39 general anesthetics, 17 monitored anesthetic care cases, and two regional anesthetics. The patients exhibited normal responses to succinylcholine, nondepolarizing neuromuscular blockers, neostigmine, induction agents, and volatile anesthetics. Serious postoperative complications related to DM2 did not occur. Conclusion In our series, patients with DM2 tolerated commonly used anesthetics without obvious complications,
Epidural Anesthesia For Laparoscopic Cholecystectomy In
The Internet Journal of …, 2007
Commonly laparoscopic cholecystectomy (LC) is performed under general anesthesia. In this report we describe the anesthetic management of a patient with dilated cardiomyopathy who underwent LC under thoracic epidural anesthesia. To the best of our knowledge this is the first report in the literature which describes epidural anesthesia for LC in a cardiac compromised patient. A 28-year old male patient presented with acute calcular cholcystitis. On examination he looked ill with shortness of breath but lying supine comfortably in bed. Neck veins were engorged with no edema in the lower limbs. On auscultation first and second sounds were audible with murmur and dropped beats. Chest-x-ray shoed left atrial enlargemen. ECG showed normal sinus rhythm, ventricular premature complexes, left atrial enlargement and possible chronic pulmonary disease pattern. Echocardiography showed severely dilated left ventricle with severe systolic dysfunction and generalized hypokinesia. Ejection fraction was 15%. Upon arrival of the patient to operation room routine monitoring were established. The measured blood pressure was 110/70 mmHg and heart rate 76/min with oxygen saturation on oxygen mask of 99%. A16G i.v and radial arterial cannulation were established under local anesthesia. Right internal jugular vein was cannulated under local anesthesia and bilumenal catheter was inserted for central venous pressure monitoring and for injecting resuscitation drugs when required. Then the patient was placed on right lateral side and thoracic epidural catheter D8-9 was inserted under complete aseptic technique. Bupivacaine 0.25% 7ml injected through the catheter with loss of sensory up to T4 dermatome. Dopamine infusion drip started at dose of 5mic/kg/min through the central venous line. Foleys catheter was inserted. The mean range of blood pressure intraoperatively was 94-110mmHg and CVP ranged from 26-3 mmHg. Sedation was achieved with 3mg i.v midazolam. Total fluids received 700 ml of crystalloids. Total urine output was 300ml. Surgery took 60min with CO2 insufflation pressure <10mmHg and was uneventful. Through out the procedure the vital signs were stable and the patient was comfortable. At the end of the procedure he was transferred to intensive care unit awake with stable vital signs. Next day he was transferred to the surgical floor.
Anesthetic Management In Patient With Laparoscopic Cholesistectomy
Proceedings of Malikussaleh International Conference on Health and Disaster Medicine (MICOHEDMED)
Cholelithiasis is one of the most common diseases. One of the treatments that can be done is a laparoscopic cholecystectomy. This action is one type of minimally invasive procedure that aims to minimize trauma from the process, which aims to minimize trauma from the surgical process but with satisfactory results. Laparoscopy is a minimally invasive surgical procedure by introducing CO2 gas into the peritoneal cavity to create a space between the anterior abdominal wall and the viscera, thereby providing endoscopic access into the peritoneal cavity. Anesthesia induction was performed under general anesthesia with intubation. The procedure was successful and the patient returned to the ward in good condition.
Role of spinal anaesthesia and general anaesthesia during laparoscopic cholecystectomy
Combining minimal invasive surgical and lesser invasive anesthesia technique reduces morbidity and mortality. The aim of the study is to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy. The study was done in Shantiram medical college and general hospital, nandyal. 50 healthy patients were randomized under spinal anesthesia (n=25) & General Anesthesia (n=25). Hyperbaric 3ml bupivacaine plus 25mcg fentanyl was administered for spinal group and conventional general anesthesia for GA group. Intraoperative parameters and post-operative pain and recovery were noted. Under spinal group any intraoperative discomfort were taken care by reassurance, drugs or converted to GA. Questionnaire forms were provided for patients and surgeons to comment about the operation. None of the patients had significant hemodynamic and respiratory disturbance except for transient hypotension and bradycardia. Operative time was comparable. 4 patients under spinal anesthesia had right shoulder pain, 1 patients were converted to GA and 3 patients were managed by injection midazolam and infiltration of lignocaine over the diaphragm. There was significant post-operative pain relief in spinal group. All the patients were comfortable and surgeons satisfied. Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery, but require cooperative patient, skilled surgeon, a gentle surgical technique and an enthusiastic anesthesiologist.
Laparoscopic cholecystectomy under spinal anesthesia
The American Journal of Surgery, 2008
Background: Advantages of laparoscopic cholecystectomy (LC) such as less pain and short hospital stay make it the treatment of choice for cholelithiasis. There are limited data about LC under spinal anesthesia. This study was designed to evaluate LC under spinal anesthesia. Methods: Twenty-nine patients underwent surgery for LC under spinal anesthesia at the 4th Department of Surgery of the Ankara Numune Education and Research Hospital between April 2005 and January 2006. All patients were informed about spinal anesthesia in detail. The patients also were informed about the risk of conversion to general anesthesia, and all patients provided informed consent. The election criteria for spinal anesthesia were as follows: American Society of Anesthesiologists (ASA) risk group 1 or 2; risk score for conversion from LC to open cholecystectomy (RSCO) less than negative 3; and presence of gallstone disease. Standard laparoscopic technique was applied to all patients. Simple questionnaire forms were developed for both patients and surgeons to provide comments about the operation. Results: The operation was completed laparoscopically on 26 patients, while 3 patients needed general anesthesia due to severe right shoulder pain. None of the patients had cardiopulmonary problems other than transient hypotension during surgery. Intravenous fentanyl (25 g) was needed in 13 patients due to severe right shoulder pain. Five patients still had severe shoulder pain after fentanyl injection. Local washing of the right diaphragm with 2% lidocaine solution was successful in the remaining 5 patients in whom fentanyl injection failed to stop the pain. All of the patients' answers to the questions regarding the comfort of operation were "very well" at the 1-month postoperative evaluation. All surgeons stated that there was no difference from LC under general anesthesia. Conclusions: All of the patients and surgeons were satisfied with LC under spinal anesthesia. Therefore, LC under spinal anesthesia may be an appropriate treatment choice to increase the number of patients eligible for outpatient surgery.
Spinal Anesthesia for Laparoscopic Cholecystectomy
In 1985, the first laparoscopic cholecystectomy was performed, and the introduction of laparoscopic cholecystectomy proved to be a new era in the management of cholelithiasis. In his only start, only patients who were good surgical risks, with non acute disease and no prior abdominal surgeries were selected for the procedure. However, as experience was gained, the pool of patients expanded to encompass those who were otherwise candidates for conventional cholecystectomy. To perform the surgery laparoscopically, there is a need to create a space between the abdominal wall and the viscera. If cholecystectomy was performed under anesthesia in high-risk patients, there is no explanation for the procedure to become routine in healthy patients. Spinal anesthesia has the advantage of providing analgesia and muscle relaxation with complete preservation of consciousness and rapid postoperative recovery. No need to change the surgical technique, only that the inflation pressure should be maintained between 8 and 10 mmHg. One of the problems is the appearance of shoulder pain, which can be seamlessly decreased with low intra-abdominal pressures and systematic use of intraperitoneal local anesthetics. Spinal anesthesia reduces the incidence of nausea and vomiting and improves postoperative pain and allows early ambulation and discharge. The cost of spinal anesthesia was 30% of general anesthesia.
2007
Background. Laparoscopic surgery is normally performed under general anaesthesia, but regional techniques have been found beneficial, usually in the management of patients with major medical problems. Encouraged by such experience, we performed a feasibility study of segmental spinal anaesthesia in healthy patients. Methods. Twenty ASA I or II patients undergoing elective laparoscopic cholecystectomy received a segmental (T10 injection) spinal anaesthetic using 1 ml of bupivacaine 5 mg ml 21 mixed with 0.5 ml of sufentanil 5 mg ml 21. Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patients were reviewed 3 days postoperatively by telephone. Results. The spinal anaesthetic was performed easily in all patients, although one complained of paraesthesiae which responded to slight needle withdrawal. The block was effective for surgery in all 20 patients, six experiencing some discomfort which was readily treated with small doses of fentanyl, but none requiring conversion to general anaesthesia. Two patients required midazolam for anxiety and two ephedrine for hypotension. Recovery was uneventful and without sequelae, only three patients (all for surgical reasons) not being discharged home on the day of operation. Conclusions. This preliminary study has shown that segmental spinal anaesthesia can be used successfully and effectively for laparoscopic surgery in healthy patients. However, the use of an anaesthetic technique involving needle insertion into the vertebral canal above the level of termination of the spinal cord requires great caution and should be restricted in application until much larger numbers of patients have been studied.