title: Inclusion body myositis and anesthesia: a case series.
abstract: OBJECTIVE
  Inclusion body myositis is a painless inflammatory myopathy affecting older adults. It manifests as progressive muscle atrophy and weakness, typically affecting proximal lower extremity muscles initially but insidiously progressing to affect other muscles, including bulbar (oropharyngeal) muscles and the diaphragm, and leading to dysphagia and respiratory insufficiency. This study reviews the perioperative outcomes of patients with inclusion body myositis who received general anesthesia.
  
  
  METHODS
  Observational retrospective study.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Patients with inclusion body myositis from October 1, 2009, to September 30, 2015, undergoing procedures requiring general anesthesia.
  
  
  METHODS
  Perioperative health records were reviewed.
  
  
  METHODS
  Perioperative outcomes and complications were assessed, with emphasis on respiratory complications and unexpected reactions to succinylcholine and nondepolarizing neuromuscular blocking drugs.
  
  
  RESULTS
  Sixteen patients with inclusion body myositis underwent 18 procedures requiring general anesthesia. Succinylcholine was used during induction in 6 cases (33.3%) and nondepolarizing neuromuscular blocking drugs in 11 cases (61.1%). For 13 patients (72.2%), the trachea was extubated at the end of surgery, and none had postoperative respiratory complications. The 5 patients who continued to have tracheal intubation were expected to require continuous mechanical ventilation postoperatively. Three patients died within 30 days of surgery. One patient underwent a tracheostomy for planned long-term mechanical ventilation but life support was withdrawn after 22 days, and 2 severely deconditioned patients died at 11 and 15 days following general anesthesia for endoscopic procedures.
  
  
  CONCLUSIONS
  Our patients with inclusion body myositis had uneventful perioperative outcomes following general anesthesia with depolarizing and nondepolarizing muscle relaxants. The small patient cohort in our series precludes a definitive conclusion regarding the safety of anesthetic agents in this patient population.
authors.affiliation: Division of Multispecialty Anesthesia, Mayo Clinic, Rochester, MN.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Mortenson
authors.affiliation: Division of Multispecialty Anesthesia, Mayo Clinic, Rochester, MN.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
authors.affiliation: Division of Multispecialty Anesthesia, Mayo Clinic, Rochester, MN.
authors.forename: Alexandre N
authors.initials: AN
authors.lastname: Cavalcante
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN; Division of Pain Medicine, Mayo Clinic, Rochester, MN.
authors.forename: James C
authors.initials: JC
authors.lastname: Watson
authors.affiliation: Division of Multispecialty Anesthesia, Mayo Clinic, Rochester, MN. Electronic address: weingarten.toby@mayo.edu.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018979:Myositis, Inclusion Body / Q000150:complications / Q000601:surgery*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D012189:Retrospective Studies; D013390:Succinylcholine / Q000009:adverse effects*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine
keywords: Adverse events; General anesthesia; Inclusion body myositis; Nondepolarizing neuromuscular blocking drug; Respiratory failure; Succinylcholine