[Anesthetic case report of a patient with chronic inflammatory demyelinating polyneuropathy].
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease characterized by progressive neurological distress and motor weakness in the legs and arms. We report a patient with CIDP who underwent thoracoscopic surgery under general anesthesia. A 43-year-old man was hospitalized for examination of unidentified fever, and PET detected accumulations in the inguinal and mediastinal lymph nodes. The inguinal lymph node biopsy could not reveal the cause, and he was scheduled for thoracoscopic mediastinal lymph node biopsy. He had been diagnosed CIDP by lower motor weakness and sensory disorder for five months, and underwent peritoneal dialysis for chronic renal failure over the past nine months. Anesthesia was induced with propofol, remifentanil, and high-dose sevoflurane. He could be intubated easily with a left-sided Broncho-Cath double-lumen tube with no muscle relaxants. Anesthesia was maintained by sevoflurane (1.5-1.7%) and remifentanil (0.10-0.15 microg x kg(-1) x min(-1)). After the operation, spontaneous respiration appeared immediately after discontinuing anesthetics. Endotracheal tube was removed because of the following data; Sp(O2), 99%; tidal volume, about 600 ml; respiratory rate, 12-15 min(-1); level of consciousness was good. Arterial blood gas determination at this time revealed pH, 7.418: Pa(CO2), 36.0 mmHg : Pa(O2), 329.3 mmHg under 8 l x min(-1) oxygen. The patient showed an uncomplicated postoperative course.
Department of Anesthesiology, Yokohama City University Medical Center, Yokohama 232-0024.
Rieko
R
Kashiwagi
Yoshikazu
Y
Nishimura
Haruko
H
Nishikawa
Minako
M
Satoh
Keiko
K
Fujimoto
Kaoru
K
Okazaki
D000328:Adult; D000768:Anesthesia, General; D001706:Biopsy; D006801:Humans; D007442:Intubation, Intratracheal; D008198:Lymph Nodes; D008297:Male; D008482:Mediastinum; D009125:Muscle Relaxants, Central; D010530:Peritoneal Dialysis; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D013906:Thoracoscopy
D009125:Muscle Relaxants, Central