Postoperative hypotonia in a patient with stiff person syndrome: a case report and literature review

Abstract

Purpose Stiff person syndrome (SPS), an autoimmune disease that manifests with episodic muscle rigidity and spasms, has anesthetic considerations because postoperative hypotonia may occur. This hypotonia has been linked to muscle relaxants and volatile anesthetics and may persist in spite of neostigmine administration and train-of-four (TOF) monitoring suggesting full reversal. We present a patient with SPS who experienced hypotonia following total intravenous anesthesia (TIVA), which was promptly reversed with sugammadex. These observations are considered in light of the relevant medical literature. Clinical features A 46-yr-old female patient with SPS underwent breast lumpectomy and sentinel node biopsy. Anesthesia consisted of TIVA (propofol/remifentanil) with adjunctive administration of rocuronium 20 mg to obtain adequate intubating conditions. Despite return of the TOF ratio to 100% within 30 min, hypotonia was clinically evident at conclusion of surgery two hours later.

Remimazolam and Remifentanil Anesthetics for an Adolescent Patient with Stiff-Person Syndrome: A Case Report

“…4 Additionally, a patient who was anesthetized with total intravenous anesthesia, including propofol showed postoperative hypotonia, despite recovery from muscle relaxant on train-of-four monitoring. 8…”

“…4 Additionally, a patient who was anesthetized with total intravenous anesthesia, including propofol showed postoperative hypotonia, despite recovery from muscle relaxant on train-of-four monitoring. 8 Remimazolam has several advantages in patients with SPS. Remimazolam exerts its sedative effects by facilitating the binding of GABA to GABA type A receptors at the benzodiazepine binding site.…”

Discovery of potential natural dihydroorotate dehydrogenase inhibitors and their synergism with brequinar via integrated molecular docking, dynamic simulations and in vitro approach

“…Brequinar is an immunosuppressive and antitumor agent, whilst leflunomide indicates immunosuppressive activity [23][24][25] . However, most of such immunosuppressive medications have many disadvantages and suffer from a lot of side effects as it should be administrated for long term and accompanied by adverse metabolic disturbances and toxicities, in addition to the high risk of infection, cancer incidence and lack specificity [26][27][28] . For example, leflunomide is an intense immunosuppressant agent and has been used as an effective disease modifying antirheumatic drug (DMARD).…”