Multiple system atrophy (MSA) is a neural degenerative disease, mainly of the cerebellar-extrapyramidal tract-autonomic nervous system. Complications of perioperative management include cyclical fluctuations due to autonomic dysfunction, upper airway obstruction due to vocal cord paralysis, and prolonged effects of muscle relaxants. We encountered two cases of general anesthesia in patients with MSA with different clinical findings. Case 1 involved a 79-year-old man scheduled for implant removal. He had been diagnosed with MSA 6 years previously and had recurrent fainting spells due to orthostatic hypotension. During anesthesia induction, transient hypotension was observed ; however, no excessive hypotension due to the vasopressor was observed intraoperatively. After surgery, sugammadex was administered, and the patient was extubated.
Case 2 involved a 65-year-old man who was scheduled for epulis resection and extraction. Preoperative otolaryngological examination revealed asymmetry in vocal fold movement. After the surgery, sugammadex was administered and sufficient spontaneous respiration was confirmed. The patient was extubated and it was confirmed that there was no limitation of vocal cord movement. Both two patients were discharged with no problems.
It is estimated that approximately 12,000 individuals in Japan are affected by MSA, and it is anticipated that the disease will emerge as a clinical concern in the future.
Patients with MSA have various symptoms that differ with individuals ; therefore, it is necessary to accurately assess a patient’s general condition through detailed interviews and anesthesia planning.
