Anaesthetic considerations in patients with transverse myelitis

Balakrishnan, Ira; Yadav, Naveen; Singh, Gyaninder Pal; Prabhakar, Hemanshu

doi:10.1080/22201173.2013.10872949

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…Similar complication leading to occurrence of TM has been reported by Seok et al 5 So the use of regional anesthesia as well as muscle relaxant is still debatable which is contrary from our case to the case reported above. The differences in our case report is avoidance of muscle relaxant or regional anesthesia and the use of advanced monitoring like BIS and TOF ratio which was not monitored in the cases reported by P Walsh 7 and G Weekes et al 2 . Case reported by Balakrishnan 8 is similar to our case which was done without using muscle relaxants but the TOF ratio and BIS monitoring was not done.…”

Section: Discussionmentioning

confidence: 67%

Anesthesia For Laparoscopic Cholecystectomy In A Patient With Transverse Myelitis: A Case Report

Sharma

Khatiwoda²,

Khanal³

et al. 2021

Nep. Mediciti Med. J.

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Background: Transverse Myelitis is a rare inflammatory disorder of the spinal cord presenting with sensory, motor, and autonomic dysfunction. Patients of transverse myelitis may present to operation theater for a variety of surgical procedures. The debilitating nature of the disease and interaction with anesthetic agents poses serious challenges during perioperative period. Choice of anesthesia is debatable but the complication following anesthesia can be prevented with thorough preoperative preparation and judicious use of anesthetic agent with neuromuscular monitoring. We present a successful conduction of laparoscopic cholecystectomy in a patient with transverse myelitis. Case Presentation: A 55-year-old female who was a known case of transverse myelitis presented for laparoscopic cholecystectomy to remove a gall bladder polyp. Except for weakness in bilateral lower limbs which had improved since her diagnosis of transverse myelitis two months back, she had no significant past medical and surgical history. Considering the grave possibility of malignant potential in polyp, cholecystectomy was urgent. Her vitals were within normal limits. Other systemic examinations revealed no abnormalities. She was planned under general anesthesia with avoidance of muscle relaxants and intraoperative use of bispectral index and train-of-four monitoring. The intra-operative period was successfully managed with propofol induction, fentanyl as analgesia, I-gel for maintenance of airway, and isoflurane for maintenance of anesthesia. Bispectral index was targeted to 40-60. Intra-operative, and post-operative period was uneventful and she had no exacerbation in her symptoms in the subsequent follow-up. Conclusion: As transverse myelitis is an uncommon condition and often not encountered routinely, the patient present real anesthetic challenge for an unsuspecting anesthesiologist. The successful management of such case especially with the use of novel anesthetic monitoring technique provide us with sufficient evidence that dreadful complications of transverse myelitis like exacerbation of motor, sensory and autonomic dysfunction can be avoided.

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Section: Discussionmentioning

confidence: 67%

Anesthesia For Laparoscopic Cholecystectomy In A Patient With Transverse Myelitis: A Case Report

Sharma

Khatiwoda²,

Khanal³

et al. 2021

Nep. Mediciti Med. J.

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“…It has various etiologies, including infectious, paraneoplastic, drug-induced, autoimmune, and demyelinating diseases. In many patients, etiology remains unknown and is therefore referred to as idiopathic [ 1 , 3 , 4 ]. Neurological deficits of acute and subacute transverse myelitis typically reach a nadir within weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Later stages of the disease may display signs of autoimmune dysreflexia, including exaggerated hypertension, reflex bradycardia, and arrhythmias. Emergency drugs to control autonomic dysreflexia should be kept intraoperatively and postoperatively [ 1 , 4 , 5 ]. MRI of the spinal cord and cerebrospinal fluid analysis (cell count, proteins, glucose, oligoclonal bands, and IgG index) is mainly done to diagnose the cause of transverse myelitis.…”

Section: Discussionmentioning

confidence: 99%

“…Blood tests are used to rule out autoimmune and infectious causes. A high-dose intravenous corticosteroid (IV methylprednisolone 1 g/day for three to seven days) is the usual initial treatment started, failing which plasmapheresis is done next, although the sufficient evidence in support of the above two and other treatment options such as rituximab, azathioprine, cyclophosphamide, and IVIG is lacking [ 1 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Providing general anesthesia to these patients using muscle relaxants for intubation is also problematic. Succinylcholine use for rapid sequence induction in these patients may cause severe hyperkalemia due to denervation and upregulated acetylcholine receptors [ 4 , 9 ]. The use of non-depolarizing muscle relaxant in this disease with denervated muscle may also cause a problem, as was the case seen in the study done by Weekes et al where they used rocuronium only to find that the patient developed prolonged residual paralysis and was put on a ventilator postoperatively, which was later finally reversed by sugammadex [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Acute Transverse Myelitis in Pregnancy: The Use of ProSeal Laryngeal Mask Airway Without Curarization for Emergency Cesarean Section

Shekhar¹,

Kadian²,

Sony³

et al. 2022

Cureus

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Transverse myelitis is a rare inflammatory neurological disorder of the spinal cord that damages the myelin covering the spinal cord and thus produces sensory, motor, and autonomic symptoms. A 26-year-old primigravida of 40 weeks gestation presented to the obstetric emergency of our hospital with complaints of weakness in both lower limbs and inability to walk for four days. A diagnosis of acute transverse myelitis was made, and due to fetal distress and arrest of labor in the second stage, an emergency cesarean section was planned. Considering the risks associated with the neuraxial technique and muscle relaxants, cesarean section was planned under general anesthesia and was successfully done with ProSeal laryngeal mask airway (LMA) using propofol and sevoflurane without muscle relaxant.

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Transverse Myelitis

Luković¹,

Mankowitz²

2018

Consults in Obstetric Anesthesiology

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Anaesthetic considerations in patients with transverse myelitis

Abstract: Transverse myelitis, a disorder caused by inflammation of the spinal cord is characterised by symptoms and signs of neurological dysfunction. The involvement of

Cited by 5 publications

References 13 publications

Anesthesia For Laparoscopic Cholecystectomy In A Patient With Transverse Myelitis: A Case Report

Anesthesia For Laparoscopic Cholecystectomy In A Patient With Transverse Myelitis: A Case Report

Acute Transverse Myelitis in Pregnancy: The Use of ProSeal Laryngeal Mask Airway Without Curarization for Emergency Cesarean Section

Transverse Myelitis

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