Considerations for general anesthesia combined with epidural anesthesia in a patient with stiff-person syndrome

Emergent Anesthetic Management in a Patient Recently Diagnosed With Stiff Person Syndrome

Stiff person syndrome (SPS) is a rare autoimmune neurological disorder characterized by muscle rigidity and episodic spasms that involve axial and limb musculature. It has important implications during anesthesia, as it leads to gamma-aminobutyric acid (GABA)-mediated inhibitory networks malfunction. This report describes the anesthetic management of a 56-year-old patient with SPS and hereditary spherocytosis undergoing emergent splenectomy due to splenic hematoma and hemoperitoneum after a fall. Total intravenous anesthesia (TIVA) was performed with the adjunctive administration of rocuronium in order to obtain adequate intubation and surgical conditions. Careful management of patients with SPS is strongly suggested given their sensitivity to inhalational anesthetics and neuromuscular blockers, which can lead to hypotonia and muscle weakness requiring maintenance of mechanical ventilation in the postoperative period.

Remimazolam and Remifentanil Anesthetics for an Adolescent Patient with Stiff-Person Syndrome: A Case Report

Stiff-person syndrome (SPS) is a rare autoimmune disease characterized by fluctuating rigidity and stiffness of the axial muscles. There are no reports on the use of remimazolam in a patient with SPS. A 16-year-old Japanese woman with SPS was scheduled to undergo intrathecal baclofen pump exchange. General anesthesia was induced and maintained using remimazolam, remifentanil, and intermittent rocuronium bromide. No intraoperative mobility or significant autonomic symptoms were observed. Additionally, electroencephalographic signature showed sufficient anesthetic depth. The patient's emergence from general anesthesia was uneventful. In conclusion, remimazolam could be considered an effective anesthetic drug for patients with SPS.

Anesthetic management of a parturient with Stiff person syndrome for urgent cesarean delivery

Stiff person syndrome is a rare neurologic disorder with an estimated incidence of 1:1000000. The underlying pathophysiology is truncal and proximal limb muscle stiffness resulting from continuous co-contracture of agonist and antagonist muscle groups concomitant with superimposed episodic muscle spasms. Loss of gamma-aminobutyric acid-mediated inhibition creates chronic excitation manifested by tonic agonist-antagonist muscle contraction. To date, only three case reports referred indirectly to the anesthetic management of parturients with Stiff person syndrome. The authors describe their management of a parturient with Stiff person syndrome who underwent urgent cesarean delivery under epidural anesthesia.

Anaesthetic management of Stiff Man syndrome

Stiff Man syndrome or stiff-person syndrome is a rare autoimmune disorder. It is characterized by increased axial muscular tone and limb musculature, and painful spasms triggered by stimulus. The case is presented of a 44-year-old man with stiff-person syndrome undergoing an injection of botulinum toxin in the urethral sphincter under sedation. Before induction, all the surgical team were ready in order to minimise the anaesthetic time. The patient was monitored by continuous ECG, SpO2 and non-invasive blood pressure. He was induced with fractional dose of propofol 150 mg, fentanyl 50 μg and midazolam 1mg. Despite careful titration, the patient had an O2 saturation level of 90%,which was resolved by manual ventilation. There was no muscle rigidity or spasm during the operation. Post-operative recovery was uneventful and the patient was discharged 2 days later. A review of other cases is presented. The anaesthetic concern in patients with stiff-person syndrome is the interaction between the anaesthetic agents, the preoperative medication, and the GABA system. For a safe anaesthetic management, total intravenous anaesthesia is recommended instead of inhalation anaesthetics, as well as the close monitoring of the respiratory function and the application of the electrical nerve stimulator when neuromuscular blockers are used.

The challenge of orbital decompression in a patient with multiple autoimmune diseases and graves' orbitopathy: a case report and review of literature

The association between multiple autoimmune diseases can make management of the ocular proptosis very difficult and challenging for the orbit surgeon. We report an interesting case of a patient affected by Stiff person syndrome, type-1 diabetes and Graves' disease with Graves' orbitopathy, who underwent orbital decompression. Anaesthesiologic problems, as well as factors affecting the post-operative result, are discussed in detail; pertinent literature review was performed and discussed.