Neuromuskuläre Blockade mit Atracurium bei Dermatomyositis

Zusammenfassung

Im vorliegenden Fallbericht wurde die Relaxierung einer 53jährigen Patientin mit Dermatomyositis mit dem nichtdepolarisierenden Muskelrelaxans Atracurium relaxometrisch gemessen. Die Intubationsdosis betrug 0,35 mg/kg KG, nach einer Narkosedauer von 50 min wurde eine Repetitionsdosis von 0,07 mg/kg KG nachgegeben. Die Ergebnisse zeigten bei dieser Patientin eine leicht erhöhte Empfindlichkeit auf Atracurium. Da bei der Relaxierung von Patienten mit Dermatomyositis hinsichtlich der Auswahl und der Dosierung der Relaxanzien wenige und z.T. widersprüchliche Erkenntnisse vorliegen, möchten wir mit unserer Beobachtung dazu beitragen, die bisherigen Kenntnisse zu erweitern.

Abstract

Dermatomyositis (DM) is a rare disease of unknown aetiology involving weakness of proximal muscles, myalgia and impairment of the integument. Due to its low incidence, only few reports exist on the anaesthesiologic management of neuromuscular blockade in patients with DM considered for surgical therapy. In this setting, special attention should be given to the administration of muscle relaxants since an increased sensitivity to these drugs in neuromuscular diseases may be expected.

Methods. This case report describes the neuromuscular monitoring of a female patient aged 53 years with DM undergoing strumectomy and treated with methotrexate and prednylidene. Muscle relaxation was induced with 0.35 mg/kg atracurium (1.5×ED₉₅). An additional bolus of 0.07 mg/kg was administered 50 min later. Control of sufficient relaxation was performed by tactile methods, and time of onset (TO), duration of action (DA) and recovery index (RI) were measured.

Results. Relaxation was obtained within TO of 3 min, DA of 50 min and RI of 11 min. These timer indicate slightly increased sensitivity to atracurium. The postoperative outcome demonstrated no muscular weakness and sufficient spontaneous ventilation.

Discussion. To date, few experiences of neuromuscular blockade with atracurium in DM have been presented, hence this report. In addition, no standard recommendations are given regarding the application of nondepolarizing muscle relaxants in this context. In our case, atracurium could be implemented as a safe drug under neuromuscular monitoring.