López Álvarez A, Román Fernández A, Vilanova Vázquez V, Corujeira Rivera M C, Areán González I, Valiño Hortas C
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain.
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Meixoeiro de Vigo (Complejo Hospitalario Universitario de Vigo), Vigo, Spain.
Rev Esp Anestesiol Reanim. 2014 Aug-Sep;61(7):385-7. doi: 10.1016/j.redar.2013.06.014. Epub 2013 Sep 12.
We report the anesthetic management with total intravenous anesthesia of a 61-year-old male diagnosed with limb-girdle muscular dystrophy admitted for replacement of ascending aorta due to an aortic aneurysm. Limb-girdle muscular dystrophy belongs to a genetically heterogeneous group of muscular dystrophies involving shoulder and hip girdles. Although the risk of malignant hyperthermia does not seem to be increased in these patients compared with the general population, the exposure to inhaled anesthetics and succinylcholine should probably be avoided because these patients have a predisposition to hyperkalemia and rhabdomyolysis. We chose to use total intravenous anesthesia with propofol, remifentanil and muscle relaxants to reduce oxygen consumption, and later to reduce the doses of propofol and remifentanil. The combination of a carefully planned anesthetic strategy, anesthetic depth, and neuromuscular blockade monitoring is explained.
我们报告了一例61岁男性患者的麻醉管理情况，该患者被诊断为肢带型肌营养不良，因主动脉瘤入院接受升主动脉置换术，采用全静脉麻醉。肢带型肌营养不良属于一组涉及肩胛带和骨盆带的遗传性异质性肌营养不良症。虽然与普通人群相比，这些患者发生恶性高热的风险似乎并未增加，但应避免使用吸入性麻醉剂和琥珀酰胆碱，因为这些患者易发生高钾血症和横纹肌溶解。我们选择使用丙泊酚、瑞芬太尼和肌肉松弛剂进行全静脉麻醉，以减少氧耗，随后减少丙泊酚和瑞芬太尼的剂量。文中解释了精心规划的麻醉策略、麻醉深度和神经肌肉阻滞监测的联合应用。
