[Anesthesia in myotonia]

[Anaesthetic management of patients with Steinert myotonia: two case reports]

Steinert disease, the most common myopathy in adults, is a challenge for anaesthesiologists and critical care physicians during the perioperative time. The risk of myotonic crisis, malign hyperthermia and the increased sensitivity to anaesthetic drugs shouldn't be forgotten. On contrary, Steinert disease is rarely revealed in the postoperative period. It should be evoked in case of postoperative pulmonary complications such as difficult weaning with neurological symptoms like hypotonia or muscular weakness.

[Use of Diprivan in muscular diseases and malignant hyperthermia]

An unknown myopathy can be revealed by the administration of an anaesthetic agent. The symptoms are those of malignant hyperpyrexia (MH). The MH phenotype can be detected by means of contracture tests in vitro. All anaesthetics, excepting the triggering agents, can be given. The safety of propofol as an induction and maintenance agent in this category of patients has been demonstrated. When the presence of a myopathy is known before an anaesthetic, the administration of succinylcholine associated or not with a halogenated inhalational agent carries a risk of severe complication. Among the anaesthetic agents having little effect on the skeletal muscle, propofol seems interesting, also because of its pharmacokinetic properties. Myopathy is difficult to diagnose, either because the patient undergoes surgery before being symptomatic or because he is only a carrier of MH. In case of an abnormal reaction following the administration of recognized triggering agents or the occurrence of MH, the procedure should be discontinued. In case of absolute necessity, the procedure may be continued but with non-triggering agents only.