title: [Anesthesia for pneumothorax surgery in a patient with type II chronic respiratory failure associated with inclusion body myositis].
abstract: A 40-year-old man was scheduled for video assisted thoracoscopic surgery due to pneumothorax. He had been diagnosed with inclusion body myositis and received nocturnal non-invasive positive pressure ventilation. Anesthesia was induced with propofol, remifentanil, and rocuronium, and maintained with propofol, remifentanil and fentanyl. The dosage of rocuronium was 10 mg. Although we administered neostigmine at the end of the operation and TOF ratio was over 90%, he was transported to the ICU with tracheal intubation because of poor spontaneous respiration. On POD 1, the tracheal tube was extubated and NPPV was administered again. Minitrach was inserted on POD 2, and he left the ICU on POD 4. Generally, in patients with myopathy the dose of muscle relaxant should be decreased in proportion to their muscle atrophy. Rocuronium 10 mg was administered in this case and we thought it could be antagonized by neostigmine, but extubation on the day of operation was impossible. We think this is not because of the residual effect of muscle relaxant, but because of decreases in pulmonary function. In this case, we expected long-term mechanical ventilation might be necessary, but he showed a good postoperative course owing to minimally invasive surgery, NPPV, and suctioning of sputum via Minitrach.
authors.affiliation: Department of Anesthesiology, Tohoku Yakkadaigaku Hospital, Sendai 983-8512.
authors.forename: Yui
authors.initials: Y
authors.lastname: Igari
authors.affiliation: Department of Anesthesiology, Tohoku Yakkadaigaku Hospital, Sendai 983-8512.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Anesthesiology, Tohoku Yakkadaigaku Hospital, Sendai 983-8512.
authors.forename: Kei
authors.initials: K
authors.lastname: Nagaya
mesh_terms: D000732:Androstanols / Q000008:administration & dosage; D000771:Anesthesia, Intravenous; D002908:Chronic Disease; D006801:Humans; D008297:Male; D018979:Myositis, Inclusion Body / Q000150:complications*; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D019990:Perioperative Care; D011013:Pneumonectomy; D011030:Pneumothorax / Q000209:etiology* / Q000601:surgery*; D011175:Positive-Pressure Respiration; D012131:Respiratory Insufficiency / Q000209:etiology*; D000077123:Rocuronium; D013183:Sputum; D013396:Suction; D013906:Thoracoscopy; D016896:Treatment Outcome
chemical_list: D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D000077123:Rocuronium