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Miyoshi H, Otsuki S, Mukaida K, Kido K, Sumii A, Ikeda T, Noda Y, Yasuda T, Narasaki S, Kato T, Kamiya S, Horikawa YT, Tsutsumi YM. Effects of Remimazolam on Intracellular Calcium Dynamics in Myotubes Derived from Patients with Malignant Hyperthermia and Functional Analysis of Type 1 Ryanodine Receptor Gene Variants. Genes (Basel) 2023; 14:2009. [PMID: 38002952 PMCID: PMC10671487 DOI: 10.3390/genes14112009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Remimazolam is a novel general anesthetic and its safety in patients with malignant hyperthermia (MH) is unknown. We used myotubes derived from the skeletal muscle of patients with MH to examine the response to ryanodine receptor 1 (RYR1) agonist and remimazolam in MH-susceptible patients. Patients underwent muscle biopsy for the Ca2+-induced Ca2+ release (CICR) rate test, a diagnostic tool for MH in Japan. Ten patients had myotubes obtained from skeletal muscle cultures, and the genes associated with malignant hyperthermia in these patients were analyzed. The EC50 of caffeine, cresol, and remimazolam to induce intracellular calcium concentration change were compared between myotubes from CICR-negative genetic test patients and myotubes from other patients. Eight of the ten were CICR-positive, five of whom had RYR1 causative gene mutations or variants. Two patients had CICR-negative genetic tests, and as expected had the highest EC50 (the concentration of a drug that gives a half-maximal response) in response to caffeine, 4CmC and remimazolam. Three patients had a positive CICR but no known variants in RYR1 or CACNA1S (voltage-gated calcium channel subunit alpha1S). Myotubes in these patients had significantly lower EC50s for all agents than myotubes in CICR-negative patients. When myotubes from a patient who was CICR-negative and had no gene variant were used as a control, myotubes from CICR-positive patients were more hyper-responsive than controls to all stimulants used. The EC50 for remimazolam was lowest for myotubes from CICR-positive, RYR1-mutant patients, at 206 µM (corresponding to 123 µg/mL). The concentration was more than 80-times higher than the clinical concentration. RYR1 gene variants in R4645Q and W5020G were shown to be causative gene mutations for MH. Intracellular calcium in myotubes from MH patients are elevated at high concentrations of remimazolam but not at clinically used concentrations of remimazolam. Remimazolam appears to be safe to use in patients with MH.
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Affiliation(s)
- Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Sachiko Otsuki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Keiko Mukaida
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Kenshiro Kido
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Ayako Sumii
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Tsuyoshi Ikeda
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Yuko Noda
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Toshimichi Yasuda
- Department of Anesthesiology, Hiroshima Prefectural Rehabilitation Center, Hiroshima 739-0036, Japan;
| | - Soshi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Takahiro Kato
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Satoshi Kamiya
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
| | - Yousuke T. Horikawa
- CHOC Health Alliance, Children’s Hospital Orange County, Orange, CA 92868, USA;
| | - Yasuo M. Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan; (S.O.); (K.M.); (K.K.); (A.S.); (T.I.); (Y.N.); (S.N.); (T.K.); (S.K.); (Y.M.T.)
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Heiderich S, Bastian B, Johannsen S, Klingler W, Rüffert H, Schuster F. [Trigger-free anesthesia : Indications and safe application]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01311-2. [PMID: 37382624 DOI: 10.1007/s00101-023-01311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
The safe anesthesiological care of patients with neuromuscular diseases poses a particular challenge for anesthetists. Only a small group of muscle diseases and syndromes are associated with an increased risk of malignant hyperthermia and therefore require trigger-free anesthetic procedures avoiding volatile anesthetics and succinylcholine. These diseases are frequently associated with mutations in the RYR1, CACNA1S or STAC-3 genes. In other neuromuscular diseases, anesthetic-induced rhabdomyolysis can occur. Therefore, volatile anesthetics should be avoided in these patients in addition to the contraindication for succinylcholine. In other neuromuscular diseases the risk of a propofol infusion syndrome or myotonic crises can be elevated or the duration of the effect of non-depolarizing muscle relaxants can be changed in an incalculable way. In every case an individual anesthetic aproach including the avoidance of potential pharmacological or non-pharmacological triggers is essential for the safety of the patients.
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Affiliation(s)
- Sebastian Heiderich
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - Börge Bastian
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Stephan Johannsen
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Werner Klingler
- Fachabteilung für Anästhesie, Intensivmedizin und Schmerztherapie, SRH Kliniken Landkreis Sigmaringen, Sigmaringen, Deutschland
| | - Henrik Rüffert
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Helios Klinikum Schkeuditz, Schkeuditz, Deutschland
| | - Frank Schuster
- Institut für Anästhesiologie, Intensivmedizin und Notfallmedizin, Donau-Isar-Klinikum Deggendorf-Dingolfing-Landau, Deggendorf, Deutschland
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Toyota Y, Kondo T, Shorin D, Sumii A, Kido K, Watanabe T, Otsuki S, Kanzaki R, Miyoshi H, Yasuda T, Horikawa YT, Mukaida K, Tsutsumi YM. Rapid Dantrolene Administration with Body Temperature Monitoring Is Associated with Decreased Mortality in Japanese Malignant Hyperthermia Events. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8340209. [PMID: 36874927 PMCID: PMC9977521 DOI: 10.1155/2023/8340209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
Purpose Malignant hyperthermia (MH) is a rare genetic disorder but one of the most severe complications of general anesthesia. The mortality rate of MH has dropped from 70% in the 1960s to 15% because of dantrolene, the only currently accepted specific treatment for MH. In this study, we retrospectively identified the optimal dantrolene administration conditions to reduce MH mortality further. Methods Our database performed a retrospective analysis of patients with MH clinical grading scale (CGS) grade 5 (very likely) or 6 (almost certain) between 1995 and 2020. We examined whether dantrolene administration affected mortality and compared the clinical variables associated with improved prognosis. Furthermore, a multivariable logistic regression analysis was used to identify specific variables associated with improved prognosis. Results 128 patients met the inclusion criteria. 115 patients were administered dantrolene; 104 survived, and 11 died. The mortality rate of patients who were not administered dantrolene was 30.8%, which was significantly higher than those of patients who were administered dantrolene (P = 0.047). Among patients administered dantrolene, the interval from the first sign of MH to the start of dantrolene administration was significantly longer in the deceased than in the survivors (100 min vs. 45.0 min, P < 0.001), and the temperature at the start of dantrolene administration was also significantly higher in the deceased (41.6°C vs. 39.1°C, P < 0.001). There was no significant difference in the rate of increase in temperature between the two, but there was a substantial difference in the maximum temperature (P < 0.001). The multivariable analysis also showed that the patient's temperature at dantrolene administration and interval from the first MH sign to dantrolene administration was significantly associated with improved prognosis. Conclusions Dantrolene should be given as rapidly as possible once MH has been diagnosed. Beginning treatment at a more normal body temperature can prevent critical elevations associated with a worse prognosis.
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Affiliation(s)
- Yukari Toyota
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Takashi Kondo
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Daiki Shorin
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Ayako Sumii
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenshiro Kido
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoyuki Watanabe
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Sachiko Otsuki
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Rieko Kanzaki
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshimichi Yasuda
- Department of Anesthesiology, Hiroshima Prefectural Rehabilitation Center, Higashi, Hiroshima, Japan
| | - Yousuke T. Horikawa
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
- Department of Pediatrics, Sharp Rees-Stealy Medical Group, San Diego, CA, USA
| | - Keiko Mukaida
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasuo M. Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
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Tsutsumi YM, Kakuta N, Kawanishi R, Tanaka K, Kanzaki R, Morio A, Noda Y, Miyoshi H, Kondo T, Mukaida K. Malignant hyperthermia in a 16-day-old infant with congenital diaphragmatic hernia: a case report. J Anesth 2021; 35:311-314. [PMID: 33625594 DOI: 10.1007/s00540-021-02902-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/23/2021] [Indexed: 11/28/2022]
Abstract
Malignant hyperthermia (MH) is a severe hypermetabolic disorder associated with dysregulation of calcium homeostasis and is triggered by inhalational anesthetics (isoflurane, sevoflurane, desflurane) and a depolarizing muscle relaxant (succinylcholine). We report the case of a 16-day-old infant undergoing laparoscopic surgery. The patient developed hyperthermia and hypercarbia with muscle rigidity. After the diagnosis of MH, dantrolene was administered with sufficient hydration. The patient was transferred to the pediatric intensive care unit for monitoring and treatment of acute renal injury due to myoglobinuria. Subsequently, two variants of the ryanodine receptor 1 (RYR1) gene were identified in the patient as the mutation point at c.1589G > A p.Arg530His and c.1841G > T p.Arg614Leu, which are known to be associated with MH. This was a rare case of MH in a 16-day-old infant that might be related to two RYR1 mutations inherited from the parents.
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Affiliation(s)
- Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan.
| | - Nami Kakuta
- Department of Anesthesiology, Tokushima University, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Ryosuke Kawanishi
- Department of Anesthesiology, Tokushima University, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Rieko Kanzaki
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Atsushi Morio
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Yuko Noda
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Takashi Kondo
- Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, 734-8551, Japan
| | - Keiko Mukaida
- Department of Anesthesiology, Hiroshima Prefectural Rehabilitation Center, Higashi-Hiroshima, 739-0036, Japan
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Watanabe T, Miyoshi H, Noda Y, Narasaki S, Morio A, Toyota Y, Kimura H, Mukaida K, Yasuda T, Tsutsumi YM. Effects of Remimazolam and Propofol on Ca 2+ Regulation by Ryanodine Receptor 1 with Malignant Hyperthermia Mutation. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8845129. [PMID: 33490280 PMCID: PMC7801102 DOI: 10.1155/2021/8845129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/21/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND We investigated the potential safety of remimazolam and propofol in malignant hyperthermia- (HM-) susceptible patients using ryanodine receptor 1- (RYR1-) expressing human embryonic kidney- (HEK-) 293 cells. METHODS We compared the enhanced responsiveness of HEK-293 cells expressing wild-type RYR1 with that of mutant RYR1 to caffeine following perfusion with remimazolam or propofol. Furthermore, we investigated whether RYR1 enhanced the responsiveness of cells to remimazolam or propofol and compared the median effective concentration (EC50; i.e., the concentration required to reach half-maximal activation) using an unpaired two-tailed t-test while a P < 0.05 was considered significant. RESULTS Remimazolam and propofol did not promote the caffeine-induced increase in intracellular Ca2+ levels in HEK-293 cells expressing mutant RYR1 even with exposure to approximately 100-fold the clinically used concentration. In wild-type RYR1, EC50 values of remimazolam following refusion vs. nonperfusion were 2.86 mM vs. 2.75 mM (P = 0.76) while for propofol perfusion vs. nonperfusion, they were 2.76 mM vs. 2.75 mM, respectively (P = 0.83). In mutant RYR1, EC50 values of remimazolam refusion vs. nonperfusion were 1.58 mM vs. 1.71 mM, respectively (P = 0.63) while for propofol perfusion vs. nonperfusion, they were 1.65 mM vs. 1.71 mM, respectively (P = 0.73). Remimazolam and propofol increased intracellular Ca2+ levels in a concentration-dependent manner, but the effect was not enhanced by RYR1. EC50 values of remimazolam with non-RYR1 vs. wild-type RYR1 were 1.00 mM vs. 0.92 mM, respectively (P = 0.91) while those of propofol were 1.09 mM vs. 1.05 mM, respectively (P = 0.84). CONCLUSIONS The increase in intracellular Ca2+ concentration caused by remimazolam or propofol was not considered an RYR1-mediated reaction. We conclude that remimazolam and propofol can be safely used as an anesthetic in MH-susceptible patients with RYR1-mutation without causing MH and may be safely substituted for an MH-triggering anesthetic when RYR1-mediated MH occurs.
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Affiliation(s)
- Tomoyuki Watanabe
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Hirotsugu Miyoshi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Yuko Noda
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Soshi Narasaki
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Atsushi Morio
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Yukari Toyota
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Hiroshi Kimura
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Keiko Mukaida
- Department of Anesthesiology, Hiroshima Prefectural Rehabilitation Center, Higashihiroshima 739-0036, Japan
| | - Toshimichi Yasuda
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
| | - Yasuo M. Tsutsumi
- Department of Anesthesiology and Critical Care, Hiroshima University, Hiroshima 734-8551, Japan
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Functional analysis of newly identified RYR1 variants in patients susceptible to malignant hyperthermia. J Anesth 2020; 34:658-665. [PMID: 32535660 DOI: 10.1007/s00540-020-02803-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/23/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE This study aimed to evaluate whether the three ryanodine receptor type 1 (RYR1) variants (p.Ser2345Thr, p.Ser2345Arg, and p.Lys3367Arg) which we identified in Japanese malignant hyperthermia (MH) patients with a clinical grading scale rank of 6 were causative for MH. METHODS We prepared human embryonic kidney (HEK)-293 cells transfected with wild-type RYR1 or one of the RYR1 variants, along with myotubes cultured from muscle pieces. Calcium kinetics were examined by calculating the 340/380-nm ratio under various caffeine and 4-chloro-m-cresol (4CmC) concentrations with the ratiometric dye Fura-2 AM. Half-maximal effective concentration (EC50) values were calculated from dose-response curves. Statistical analysis was based on one-way analysis of variance with a Dunnett's multiple comparison test, using a P value < 0.05 as evidence of statistical significance. RESULTS In functional analysis using HEK-293 cells, we found significant reductions in the EC50 of p.Ser2345Thr and p.Ser2345Arg in comparison with wild-type RYR1 (P < 0.001), while the EC50 of p.Lys3367Arg was not significantly different (P = 0.062 for caffeine and P > 0.999 for 4CmC). On the other hand, functional analysis using myotubes showed significant differences in the EC50 values for all variants (P < 0.001 for all comparisons). CONCLUSIONS p.Ser2345Thr and p.Ser2345Arg appear capable of causing a calcium metabolism disorder that leads to the onset of MH, and p.Ser2345Arg can be considered as a diagnostic mutation, because it meets the European Malignant Hyperthermia Group criteria. However, patients with p.Lys3367Arg might have mutations in genes other than RYR1 that are capable of causing MH.
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Kolovou G, Cokkinos P, Bilianou H, Kolovou V, Katsiki N, Mavrogeni S. Non-traumatic and non-drug-induced rhabdomyolysis. Arch Med Sci Atheroscler Dis 2019; 4:e252-e263. [PMID: 32368681 PMCID: PMC7191942 DOI: 10.5114/amsad.2019.90152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/10/2019] [Indexed: 01/19/2023] Open
Abstract
Rhabdomyolysis (RM), a fortunately rare disease of the striated muscle cells, is a complication of non-traumatic (congenital (glycogen storage disease, discrete mitochondrial myopathies and various muscular dystrophies) or acquired (alcoholic myopathy, systemic diseases, arterial occlusion, viral illness or bacterial sepsis)) and traumatic conditions. Additionally, RM can occur in some individuals under specific circumstances such as toxic substance use and illicit drug abuse. Lipid-lowering drugs in particular are capable of causing RM. This comprehensive review will focus on non-traumatic and non-drug-induced RM. Moreover, the pathology of RM, its clinical manifestation and biochemical effects, and finally its management will be discussed.
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Affiliation(s)
- Genovefa Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Philip Cokkinos
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Vana Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
- Molecular Immunology Laboratory, Onassis Cardiac Surgery Center, Athens, Greece
| | - Niki Katsiki
- First Department of Internal Medicine, Division of Endocrinology-Metabolism, Diabetes Center, AHEPA University Hospital, Thessaloniki, Greece
| | - Sophie Mavrogeni
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
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Anesthetic management of a patient with limb-girdle muscular dystrophy 2B:CARE-compliant case report and literature review. BMC Anesthesiol 2019; 19:155. [PMID: 31421689 PMCID: PMC6698341 DOI: 10.1186/s12871-019-0813-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Limb-girdle muscular dystrophies (LGMDs) belong to few neuromuscular disorders mainly involving pelvic and shoulder girdle muscles. Also, cardiac or pulmonary complications, increased rhabdomyolysis risk when exposed to volatile anesthetics and succinylcholine may increase anesthesia related risks. However, current reports about the anesthesia management of these patients are limited. Case presentation We described our anesthetic management of a 36 years old woman with LGMD 2B receiving arthroscopic knee surgery. In consideration of the high risk of rhabdomyolysis, total intravenous anesthesia (TIVA) was selected for her surgery. Considering the unpredictable respiratory depression, opioid based patient-controlled intravenous analgesia was replaced with an intra-articular cocktail therapy consisting of 20 ml of 0.2% ropivacaine. Also, we reviewed the literatures on anesthetic management of LGMD through searching PubMed, in order to provide a comprehensive and safe guidance for the surgery. Conclusions Carefully conducted general anesthesia with TIVA technique is a good choice for LGMD patients. Neuraxial anesthesia may be used if general anesthesia needs to be avoided. To warrant safe anesthesia for surgery, any decision must be well thought out during perioperative period.
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