Abstract
We reported the anesthetic management of three patients with polymyositis/dermatomyositis.
Case 1: 60-year-old man who was suffered from dermatomyositis, interstitial pneumonia and gastric cancer was scheduled for partial gastrectomy under general anesthesia. Anesthesia was induced and maintained with GOF. Pancuronium bromide was used for intubation only 4 mg and was reversed with atropine and neostigmine postoperatively, but extubation was done after four hours' careful observation.
Case 2: 63-year-old man who was diagnosed as acute appendicitis was emergently operated for appendectomy under spinal anesthesia. Polymyositis was suspected preoperatively, but confirmed postoperatively.
Case 3: 58-year-old woman who was treated for polymyositis and rheumatoid arthritis was diagnosed as ovarial tumor and was scheduled for transabdominal hysterectomy and bilateral adnexectomy under epidural anesthesia. Thoracic and lumbar epidural catheters were inserted. The tumor was revealed as ovarial cancer and additional omentectomy was done under epidural anesthesia uneventfully
Polymyositis/dermatomyositis affects not only the systemic muscles but also the laryngopharyngeal muscles, cardiac muscles and interstitium of the lung. Therefore, careful preoperative evaluations for these organs should be needed. And then decision making for optimal anesthetic regimen including in the choice of anesthesia, anesthetics and the use of muscle relaxants, and for postoperative care should be done.
