Dermatomiyozitli Bir Olguda Anestezik Yaklaşım

Abstract

Dermatomiyozit, simetrik, proksimal kas gruplarının güçsüzlüğü ve cildin kronik inflamasyonu ile karakterize progresif bir hastalıktır. Genel anestezi uygulanması gereken bu olgularda blok süresinin uzama riski nedeniyle daha az kas gevşetici ilaç kullanılmalı ve nöromüsküler monitörizasyon yapılmalıdır. Aynı zamanda aspirasyon pnömonisi, solunum kaslarının güçsüzlüğüne bağlı pulmoner komplikasyonların görülme sıklığı yüksektir. Bu olgu sunumunda intrakraniyal menengiom nedeniyle kraniyotomi yapılacak olan dermatomiyozitli bir hastada, tümörün frontal bölgede lokalize olması, kuvvet kaybının ve cerrahi sırasında motor fonksiyonların takibinin zorunlu olması nedeniyle uyanık kraniyotomi planlandı. Operasyon sırasında sadece remifentanil kullanılarak hasta takip edildi ve girişim problemsiz sonlandırıldı. Anesthetic management in a patient with dermatomyositis Dermatomyositis is a progressive disease associated with symmetrical weakness of proximal muscle groups and chronic inflammation of skin. Due to weakness of inspiratory muscles, aspiration pneumonia and incidence of pulmoner complications are high. In patients requiring general anesthesia less neuromuscular agents as well as neuromuscular monitorization should be used in order to decrease the risk of prolonged paralyses. In this case with dermatomyositis and intracranial menengioma, due to frontal localization of tumor and the necessity for evaluation of motor function during surgery, we planned awake craniotomy. Patient was followed with remifentanil infusion alone during operation and no complication occured during procedure.

Keywords

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References

1. Berkenstadt H, Perel A, Hadani M, Unofrievich I, Ram Z. 2001. Monitored anesthesia care using remifentanil and propofol for awake craniotomy. J. Neurosurg. Anesthesiol. 13, 246-249.
2. Blanshard HJ, Chung F, Manninen. PH, Taylor MD, Bernstein M. 2001. Awake craniotomy for removal of intracranial tumor: considerations for early discharge. Anesth. Analg. 92, 89-94.
3. Costello TG, Cormack JR. 2004. Anaesthesia for awake craniotomy: a modern approach. J Clin Neurosci. 11, 16-19.
4. Dalakas MC. 1994. How to diagnose and treat the inflammatory myopathies. Semin. Neurol. 14, 137.
5. Derswitz M, Hoke JF, Rosow CE, Michalowski P. 1996. Pharmakokinetics and pharmocodynamics of remifentanil in volunteers subjects with severe liver disease. Anesthesiology 84, 812-820.
6. Eisele JH. 1998. Connective tissue disease. In: Benumof JL (ed). Anaesthesia and Uncommon Diseases, Philadelphia, W.B.Saunders, 398-421.
7. Eielsen O, Stovner J. 1978. Dermatomyositis, suxamethonium action and atypical plasmacholinesterase. Can. Anaesth. Soc. J. 25, 63-64.
8. Fujita A, Okutani R, Fu K. 1996. Anesthetic management for colon resection in a patient with polymyositis. Masui. 45, 334-336.

9. Ganta R, Campbell IT, Mostafa SM. 1988. Anesthesia and acute dermatomyositis/polymyositis. Br. J. Anaesth. 60, 854-858.
10. Hepper NG, Ferguson RH, Howard FM Jr. 1964. Three types of pulmonary involvement in polymyositis. Med Clin North Am. 48, 1031-1042.
11. Johns RA, Finholt DA, Stirt JA. 1986. Anaesthetic management of a child with dermatomyositis. Can. Anaesth. Soc. J. 33, 71-74.
12. Johnson K, Egan T. 1998. Remifentanil and propofol combination for awake craniotomy: case report with pharmacokinetic simulations. J. Neurosurg. Anesthesiol. 10, 69.
13. Moore TA, Markert JM, Knowlton RC. 2006. Dexmedetomidine as rescue drug during awake craniotomy for cortical motor mapping and tumor resection. Anesth. Analg. 102, 1556-1558.
14. Ohta M, Nishikawa N, Kida H, Miyao S. 2000. Anesthetic management of two patients with polymyositis. Masui. 49, 1371-1373.
15. Rose T, Nothjunge J, Schlote W. 1985. Familial occurrence of dermatomyositis and progresive scleroderma after injection of a local anaesthetic for dental treatment. Eur. J. Pediatr. 143, 225-228.
16. Sanlı S, Kayacan N, Yeğin A, 2003. Polimiyozitli bir olguda anestezik yaklaşım. Türk Anest. Rean. Der. Dergisi. 31, 533-536.
17. Sarang A, Dinsmore J. 2003. Anaesthesia for awake craniotomy-evoluation of a technique that facilitates awake neurological testing. Br. J. Anaesth. 90, 161-165.
18. Ueki M, Tosaki Y, Ogli K, Uefuji T. 1989. Anaesthetic management of a patient with dermatomyositis-clinical observation of the effect of muscle relaxants. Masui. 38, 1505-1508.
19. Tijero T, Ingelmo I, Garcia-Trapero J, Puig A.2002. Usefulness of monitoring brain tissue oxygen pressure during awake craniotomy for tumor resection: a case report. J. Neurosurg. Anesthesiol. 14, 149-152.
20. Taylor MD, Bernstein M. 1999.Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J. Neurosurg. 90, 35-41.