METHODS: A 48-year-old male patient underwent a laparoscopic cholecystectomy for gallstones under general anesthesia. He experienced sudden cardiac arrest and respiratory failure the day after surgery. After a thorough review of past medical history, we recognized that 15 years prior, he had been diagnosed with classic type DM-1, but the diagnosis was not self-reported before general anesthesia. Symptoms of severe dysphagia developed subsequently. In a videofluoroscopic swallowing study (VFSS), we observed abrupt aggravation of myotonic dysphagia after general anesthesia. VFSS revealed cricopharyngeal opening dysfunction, with a remaining large residue in the pyriform sinus, resulting in a severe cricopharyngeal achalasia pattern.
METHODS: Acute cricopharyngeal achalasia after general anesthesia.
RESULTS: The patient underwent a dysphagia rehabilitation program that included cricopharyngeal opening exercises and functional electrical stimulation. However, no significant improvement was observed in the cricopharyngeal achalasia in a 3-month follow-up VFSS.
CONCLUSIONS: Low body temperature and anesthetic medications such as opioids and hypnotic agents can induce myotonia in the cricopharyngeal muscle.
方法:一名48岁男性患者在全身麻醉下接受腹腔镜胆囊切除术治疗胆结石。手术后的第二天,他经历了突然的心脏骤停和呼吸衰竭。在彻底回顾了过去的病史后,我们认识到15年前,他被诊断为经典型DM-1,但在全身麻醉前没有自我报告诊断.随后出现严重吞咽困难的症状。在视频透视吞咽研究(VFSS)中,我们观察到全身麻醉后肌强直性吞咽困难的突然加重。VFSS显示环咽开放功能障碍,在梨状窦中残留大量残留物,导致严重的环咽失弛缓症。
方法:全身麻醉后急性环咽失弛缓症。
结果:患者接受了吞咽困难康复计划,包括环咽开放训练和功能性电刺激。然而,在3个月的随访VFSS中未观察到环咽肌失弛缓症的显着改善。
结论:低体温和麻醉药物如阿片类药物和催眠药可诱导喉部肌强直。