[Neuromuscular blockade with atracurium in dermatomyositis]. 1995

S Röckelein, and M Gebert, and H Baar, and G Endsberger
Abteilung für Anästhesiologie und Intensivmedizin, Klinikum, Kulmbach.

Dermatomyositis (DM) is a rare disease of unknown aetiology involving weakness of proximal muscles, myalgia and impairment of the integument. Due to its low incidence, only few reports exist on the anaesthesiologic management of neuromuscular blockade in patients with DM considered for surgical therapy. In this setting, special attention should be given to the administration of muscle relaxants since an increased sensitivity to these drugs in neuromuscular diseases may be expected. METHODS. This case report describes the neuromuscular monitoring of a female patient aged 53 years with DM undergoing strumectomy and treated with methotrexate and prednylidene. Muscle relaxation was induced with 0.35 mg/kg atracurium (1.5 x ED95). An additional bolus of 0.07 mg/kg was administered 50 min later. Control of sufficient relaxation was performed by tactile methods, and time of onset (TO), duration of action (DA) and recovery index (RI) were measured. RESULTS. Relaxation was obtained within TO of 3 min, DA of 50 min and RI of 11 min. These timer indicate slightly increased sensitivity to atracurium. The postoperative outcome demonstrated no muscular weakness and sufficient spontaneous ventilation. DISCUSSION. To date, few experiences of neuromuscular blockade with atracurium in DM have been presented, hence this report. In addition, no standard recommendations are given regarding the application of nondepolarizing muscle relaxants in this context. In our case, atracurium could be implemented as a safe drug under neuromuscular monitoring.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009126 Muscle Relaxation That phase of a muscle twitch during which a muscle returns to a resting position. Muscle Relaxations,Relaxation, Muscle,Relaxations, Muscle
D009407 Nerve Block Interruption of NEURAL CONDUCTION in peripheral nerves or nerve trunks by the injection of a local anesthetic agent (e.g., LIDOCAINE; PHENOL; BOTULINUM TOXINS) to manage or treat pain. Chemical Neurolysis,Chemodenervation,Nerve Blockade,Block, Nerve,Blockade, Nerve,Blockades, Nerve,Blocks, Nerve,Chemical Neurolyses,Chemodenervations,Nerve Blockades,Nerve Blocks,Neurolyses, Chemical,Neurolysis, Chemical
D003882 Dermatomyositis A subacute or chronic inflammatory disease of muscle and skin, marked by proximal muscle weakness and a characteristic skin rash. The illness occurs with approximately equal frequency in children and adults. The skin lesions usually take the form of a purplish rash (or less often an exfoliative dermatitis) involving the nose, cheeks, forehead, upper trunk, and arms. The disease is associated with a complement mediated intramuscular microangiopathy, leading to loss of capillaries, muscle ischemia, muscle-fiber necrosis, and perifascicular atrophy. The childhood form of this disease tends to evolve into a systemic vasculitis. Dermatomyositis may occur in association with malignant neoplasms. (From Adams et al., Principles of Neurology, 6th ed, pp1405-6) Polymyositis-Dermatomyositis,Dermatomyositis, Adult Type,Dermatomyositis, Childhood Type,Dermatopolymyositis,Juvenile Dermatomyositis,Juvenile Myositis,Adult Type Dermatomyositis,Childhood Type Dermatomyositis,Dermatomyositis, Juvenile,Myositis, Juvenile,Polymyositis Dermatomyositis
D005260 Female Females
D006042 Goiter Enlargement of the THYROID GLAND that may increase from about 20 grams to hundreds of grams in human adults. Goiter is observed in individuals with normal thyroid function (euthyroidism), thyroid deficiency (HYPOTHYROIDISM), or hormone overproduction (HYPERTHYROIDISM). Goiter may be congenital or acquired, sporadic or endemic (GOITER, ENDEMIC). Goiters
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001279 Atracurium A non-depolarizing neuromuscular blocking agent with short duration of action. Its lack of significant cardiovascular effects and its lack of dependence on good kidney function for elimination provide clinical advantage over alternate non-depolarizing neuromuscular blocking agents. Atracurium Besylate,Atracurium Dibesylate,33 A 74,Atracurium Besilate,BW-33A,Relatrac,Tracrium,A 74, 33,BW 33A,BW33A,Besilate, Atracurium

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