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Challenges in the anesthetic management of a patient with Charcot-Marie-Tooth disease
The most common hereditary neuropathy, frequency – 1 in 25000. It is a progressive disease with an initial presentation – weakness in the lower limbs, and in the later stage of the disease – weakness of the hands and forearms, weakness of the respiratory muscles, disorders of the function of the diaphragm, abnormalities of the chest that lead to limited lung function and sleep apnea.
There is increased risk of MALIGNANT HYPERTHERMIA, UNPREDICTABLE RESPONSE TO NON-DEPOLARIZING NEUROMUSCULAR BLOCKERS, special attention should be paid to the PATIENT’S POSITION, avoid the use of succinylcholine due to the increased risk of HYPERKALIEMIA
A 41-year-old woman with Charcot-Marie-Tooth (CMTD) disease comes to surgery for acute cholecystitis, she was diagnosed with CMTD four years ago with pronounced weakness in the lower extremities and inability to walk without a cane, fatigue, smoker, with non-insulin-dependent diabetes mellitus
On the day of the operation, sodium-lime, filters and the anesthesia circuit were changed, residual gases from the anesthesia machine were eliminated with O2, with a flow rate of 10 L/min for 15 minutes.
Propofol was used for induction and maintenance (TIVA – total intravenous anesthesia), fentanyl as an analgesic, and atracurium for muscular paralysis.
At the end of the surgical procedure, the neuromuscular block was reversed with neostigmine and atropine, patient was extubated and admitted to the ICU overnight and discharged to the ward the next day.
What is your experience with this rare but common disease, would you do anything differently?
Another member of our NYSORA EU orthopedic surgery-anesthesia service defends a doctorate. Prof Pieter Caekebeke, congratulations!!!
Acupuncture is a traditional Chinese medical technique that plays an important role in pain control, prevention and functional improvement. In 1979, the World Health Organization (WHO) introduced acupuncture as a remedy for 43 diseases.
Good therapeutic results support the role of acupuncture as part of multimodal therapy in pain management despite no clear mechanism of action and insufficient evidence for clinically worthwhile benefit.
What is your opinion on acupuncture, is it complementary or alternative medicine and does it have a place in modern EBM?
Update on a patient with LMA regurgitation!
As soon as liquid was detected inside the LMA, we immediately removed it, and the patient was intubated.
A suction catheter was placed inside the tube and a small amount of bile-stained fluid was aspirated. Gas change was unaffected, and pressure control ventilation is started.
After the operation, the patient was extubated in the operating room, he continued to breathe spontaneously and was monitored for the next 4 days, there were no complications.
In our case, aspiration was probably caused by combination of lithotomy position and the patient medical history of diabetes. Patients with diabetes tend to be at higher risk for aspiration due to delayed gastric emptying and weak oesophageal sphincter, which is a consequence of damage to autonomic nerve fibres.
Anesthesia providers should take this into consideration in airway management.
After all this, would you place an LMA in a DM patient who will be in the lithotomy position?