Anesthetic management of a patient with chronic inflammatory demyelinating polyneuropathy by combination of total intravenous and regional anesthesia

Abstract

Chronic inflammatory demyelinating polyneuropathy (CIPD) is a rare acquired immune-mediated progressive and relapsing disorder that causes peripheral neuropathy lasting more than 2 months. We report the successful anesthetic management of a 66-year-old man with CIPD undergoing the laparoscopic Hartmann procedure. We induced and maintained total intravenous anesthesia (TIVA) using propofol, remifentanil, and ketamine without muscle relaxants. We performed ultrasound-guided transversus abdominis plane and rectus sheath blocks with 60 ml of 0.25% levobupivacaine for achieving good surgical conditions. For postoperative analgesia, we intravenously administered fentanyl (200 μg) and acetaminophen (1000 mg). The patient was uneventfully extubated in the operating room after confirming adequate spontaneous breathing. The postoperative course was uneventful without any respiratory complications such as respiratory depression, aspiration pneumonia, or progression of CIPD symptoms.

Perioperative Management of Lewis-Sumner Syndrome

“…There has also been some apprehension regarding the use of muscle relaxants in patients with neuromuscular disorders due to their increased sensitivity to non-depolarizing neuromuscular blockers and the risk of hyperkalemia with succinylcholine. In fact, Takekawa et al opted to avoid these drugs altogether and resort to a combination of general and regional anesthesia for a CIDP patient undergoing a Hartmann procedure [ 4 ].…”

Anesthetic Management of a Patient With Distal Acquired Demyelinating Symmetric (DADS) Neuropathy Under General Anesthesia

“…Non-depolarizing agents, albeit drugs of choice in these patients, may cause prolonged muscle relaxation and should be used with caution. A more recently published case report from 2019 on the anesthetic management of patients with CIDP provides evidence of the successful use of rocuronium with sugammadex in patients with CIDP and GBS, although allergic reactions to sugammadex in some patients were reported [ 7 ].…”