Anestesia para colecistectomía videolaparoscópica en paciente portador de enfermedad de Steinert. Relato de caso y revisiõn de la literatura

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Bisinotto, Flora Margarida Barra [UNESP]
Fabri, Daniel Capucci
Calçado, Maida Silva
Perfeito, Paula Borela
Tostes, Lucas Vieira
Sousa, Gabriela Denardi

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BACKGROUND AND OBJECTIVES: Myotonic dystrophies are autosomal dominant neuromuscular diseases. Among them, myotonic dystrophy type 1 (MD1), or Steinert disease, is the most common in adults, and besides muscular involvement it also has important systemic manifestations. Myotonic dystrophy type 1 poses a challenge to the anesthesiologist. Those patients are more sensitive to anesthetics and prone to cardiac and pulmonary complications. Besides, the possibility of developing malignant hyperthermia and myotonic episodes is also present. CASE REPORT: This is a 39-year old patient with DM1 who underwent general anesthesia for videolaparoscopic cholecystectomy. Total intravenous anesthesia with propofol, remifentanil, and rocuronium was the technique chosen. Intercurrences were not observed in the 90-minute surgical procedure, but after extubation, the patient developed respiratory failure and myotonia, which made tracheal intubation impossible. A laryngeal mask was used, allowing adequate oxygenation, and mechanical ventilation was maintained until full recovery of the respiratory function. The patient did not develop further complications. CONCLUSIONS: Myotonic dystrophy type 1 presents several particularities to the anesthesiologist. Detailed knowledge of its systemic involvement along with the differentiated action of anesthetic drugs in those patients will provide safer anesthetic-surgical procedure.



Complications, postoperative: respiratory failure, Diseases, muscular: myotonic dystrophy, Surgery, abdominal: cholecystectomy, atropine, carbon dioxide, creatine kinase, dipyrone, ketoprofen, metoclopramide, midazolam, neostigmine, oxygen, propofol, ranitidine, remifentanil, rocuronium, tramadol, abdominal pressure, adductor pollicis muscle, adult, anesthetic recovery, arterial gas, artificial ventilation, blood oxygen tension, blood pressure measurement, body temperature monitoring, capnography, case report, cholecystectomy, cholelithiasis, clinical feature, consciousness, continuous infusion, convalescence, cyanosis, electrocardiogram, endotracheal intubation, endotracheal tube, extubation, family history, general anesthesia, hand muscle, heart left ventricle overload, heart repolarization, hemostasis, human, intravenous anesthesia, laryngeal mask, lung function, male, muscle relaxation, myotonia, myotonic dystrophy, myotonic dystrophy type 1, operation duration, oxygenation, patient monitoring, pneumoperitoneum, pulse oximetry, respiratory failure, respiratory function, scalpel, sibling, Adult, Anesthesia, Cholecystectomy, Laparoscopic, Humans, Male, Myotonic Dystrophy, Video-Assisted Surgery

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Revista Brasileira de Anestesiologia, v. 60, n. 2, 2010.