Anesth Pain Med.  2018 Jan;13(1):61-64. 10.17085/apm.2018.13.1.61.

Response to neuromuscular blockade with rocuronium during general anesthesia in a patient with dermatomyositis: A case report

• Kim SY
• Lee YB

• KMID: 2436057
• DOI: http://doi.org/10.17085/apm.2018.13.1.61

Abstract

Dermatomyositis is an idiopathic inflammatory myopathy characterized by skin changes and muscle weakness. Depending on the involvement of various muscles, dermatomyositis can cause aspiration pneumonia, ventilatory impairment, and heart failure. Several reports have documented normal or prolonged neuromuscular blockade following administration of different non-depolarizing neuromuscular blockers in patients with dermatomyositis. We observed delayed onset of blockade and prolonged recovery following administration of 0.6 mg/kg rocuronium in a patient with dermatomyositis. However, when the train-of-four ratio reached 0.3, the patient was administered pyridostigmine and glycopyrrolate, which led to normal response to reversal of rocuronium. The patient was extubated without respiratory complications. The outcomes of this case indicate that response to the usual dosage of muscle relaxants in patients with dermatomyositis might be different from that in patients without this condition. Anesthesiologists should pay attention to preoperative cardiorespiratory evaluation and intraoperative neuromuscular monitoring.

Keyword

Dermatomyositis; Pyridostigmine bromide; Rocuronium bromide

MeSH Terms

Anesthesia, General*
Dermatomyositis*
Glycopyrrolate
Heart Failure
Humans
Muscle Weakness
Muscles
Myositis
Neuromuscular Blockade*
Neuromuscular Blocking Agents
Neuromuscular Monitoring
Pneumonia, Aspiration
Pyridostigmine Bromide
Skin
Glycopyrrolate
Neuromuscular Blocking Agents
Pyridostigmine Bromide

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