Short Communication
Anesthetic Management of a Patient with Multiple Myeloma Undergoing Surgical Treatment for Medication-related Osteonecrosis of the Jaw
2019 Volume 47 Issue 2 Pages 56-58
Details
2019 Volume 47 Issue 2 Pages 56-58
Multiple myeloma (MM) is a neoplastic proliferation of plasma cells characterized by the production of a large amount of abnormal immunoglobulin. Complications include renal impairment, hyperviscosity syndrome, amyloidosis, hypercalcemia, fractures, anemia, hemorrhagic tendency, and susceptibility to infection. We report the general anesthetic management of a patient with multiple myeloma undergoing a sequestrectomy for the treatment of medication-related osteonecrosis of the jaw (MRONJ).
An 85-year-old woman (weight, 47.7 kg ; height, 148 cm) had a 4-year history of multiple myeloma. She had multiple myeloma-related complications including moderate renal impairment, anemia, and susceptibility to infection, and had received several immuno-pharmacotherapies. To prevent multiple myeloma-related destructive bony lesions, she was medicated with intravenous zoledronic acid for 14 months, which led to the development of MRONJ. She was scheduled to undergo a mandibular sequestrectomy under general anesthesia. Anesthesia was induced with propofol and remifentanil, and a lower dosage of rocuronium (20 mg) was administered incrementally under neuromuscular monitoring before tracheal intubation. The anesthesia was maintained with desflurane and remifentanil. To avoid acute kidney failure, low-dose carperitide was administered continuously. Because the effect of rocuronium was prolonged until the end of the surgery, sugammadex was administered to reverse the effect. Low-dose unfractionated heparin was injected subcutaneously to prevent deep vein thrombosis, which could have been induced by multiple myeloma-related hyperviscosity syndrome.
Because bisphosphonates are the standard of care for the prevention of multiple myeloma-related destructive bone disease, the number of patients requiring surgical treatment for MRONJ is likely to increase. Since the symptoms of multiple myeloma vary among patients, appropriate perioperative management for each complication is required.
