Role of noninvasive ventilation in perioperative patients with neuromuscular disease: a clinical case

Abstract

The inclusion body myositis is an inflammatory myopathy that leads to chronic muscle inflammation associated with muscle weakness. It is characterized by a restrictive ventilatory syndrome requiring ventilatory support under non-invasive ventilation. The authors describe a clinical case and the anaesthetic management of a patient with inclusion body myopathy candidate for vertebroplasty, which highlights the importance of locoregional anaesthesia and of noninvasive ventilation and includes assisted cough techniques, maintained throughout the perioperative period.

Anesthetic Considerations of Sporadic Inclusion Body Myositis in an Elderly Man With Orthopedic Trauma

“…Indeed, he did not develop aspiration pneumonia after surgery. Marinho et al reported a unique approach to anesthesia in a patient with IBM who underwent percutaneous thoracic vertebral kyphoplasty in prone position ( 23 ). This patient required chronic non-invasive ventilation because of poor respiratory function.…”

“…The patient’s intraoperative care was managed using epidural anesthesia, conscious sedation, and bi-level positive airway pressure. In this case, the authors ( 23 ) avoided endotracheal intubation entirely because they were concerned that the patient’s preexisting respiratory dysfunction may preclude their ability to wean the patient from mechanical ventilation after the procedure.…”

“…The current and previous ( 20 - 23 ) cases used reduced doses of or completely avoided neuromuscular blockers in patients with IBM because of theoretically enhanced sensitivity to these drugs, but with the exception of anecdotal experience, there are no data to definitively establish the pharmacokinetics, pharmacodynamics, and relative safety of neuromuscular blockers in this setting. The actions of neuromuscular blockers may be prolonged in other forms of inflammatory myopathy, but this contention has not been examined systematically in controlled clinical trials and remains controversial, in part because inflammatory myopathies including IBM may not affect the functional integrity of the neuromuscular junction ( 1 ).…”