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Anesthetic Management for a Patient with Inclusion Body Myositis

  • NAKANO Noriyuki
    Department of Anesthesiology, Tsukuba University Hospital
  • SATSUMAE Tsuyoshi
    Department of Anesthesiology, Faculty of Medicine, University of Tsukuba
  • MIZUTANI Taro
    Department of Emergency and Critical Care Medicine, University of Tsukuba
  • KIMURA Maiko
    Department of Anesthesiology, Tsukuba University Hospital
  • TOKUWAKA Junko
    Department of Anesthesiology, Tsukuba University Hospital
  • TANAKA Makoto
    Department of Anesthesiology, Faculty of Medicine, University of Tsukuba

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Other Title
  • 封入体筋炎患者の麻酔管理

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Abstract

  Few reports have described anesthetic management for inclusion body myositis (IBM). A 76-year-old man suffering from dysphagia due to IBM underwent jejunostomy under general and epidural anesthesia. The trachea was intubated without using a muscle relaxant. The surgery was completed uneventfully. After confirming full recovery of spontaneous breathing, the trachea was extubated and he was transferred to the ward. On postoperative day 2, the patient developed aspiration pneumonia, which was successfully treated using antibiotics. Considering both this experience and previous case reports of inflammatory myopathies, we recommend using a non-depolarizing muscle relaxant during tracheal intubation. Intubation under stable conditions using these drugs may reduce the risk of aspiration during the procedure, thus minimizing the risk of postoperative pneumonia. Promotion of deep breathing and effective coughing by adequate postoperative analgesia, as well as prevention of aspiration pneumonia appear important in patients with IBM.

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