PDF(Pubmed)
Abstract：
Perioperative management of patients with myopathies can be challenging due to the increased risk of malignant hyperthermia (MH) and anesthesia-induced rhabdomyolysis (AIR). However, currently, there is no evidence regarding the optimal anesthetic management for paraneoplastic necrotizing myopathy (PNM) (total intravenous anesthetic vs. volatile anesthetics). Here, I report a case where anesthesia was administered safely using volatile anesthetics. A 63-year-old female presented with PNM associated with papillary thyroid carcinoma, necessitating urgent thyroidectomy. The patient, previously diagnosed with anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) antibody-associated myopathy, exhibited progressive weakness and dysphagia, prompting suspicion of PNM. The patient\'s compromised respiratory status, attributed to tracheal compression by a large goiter, necessitated an urgent thyroidectomy. Anesthetic management considerations included the potential effect of HMGCR-M on respiratory muscles and the need for careful planning to mitigate postoperative complications. The patient underwent total thyroidectomy, left central compartment clearance, and tracheostomy. The surgery proceeded uneventfully, with meticulous monitoring and adjustment of anesthetic agents to maintain hemodynamic stability. Postoperatively, the patient recovered well, demonstrating complete resolution of neurological symptoms during a three-month follow-up. The case underscores the importance of recognizing paraneoplastic syndromes in the context of thyroid surgery and highlights potential challenges faced by anesthesiologists. Despite the lack of established safety data for anesthetic drugs in HMGCR-M necrotizing myopathy, the case demonstrates the successful use of sevoflurane and rocuronium.
摘要：
由于恶性高热（MH）和麻醉诱导的横纹肌溶解症（AIR）的风险增加，对肌病患者的围手术期管理可能具有挑战性。然而,目前,没有证据表明副肿瘤坏死性肌病(PNM)的最佳麻醉管理(全静脉麻醉与挥发性麻醉剂)。这里,我报告了使用挥发性麻醉剂安全进行麻醉的情况。一名63岁的女性，患有与甲状腺乳头状癌相关的PNM，需要紧急甲状腺切除术。病人,先前诊断为抗3-羟基-3-甲基戊二酰辅酶A还原酶（HMGCR）抗体相关肌病，表现出进行性无力和吞咽困难，引起对PNM的怀疑。病人的呼吸状态受损,归因于大甲状腺肿压迫气管，需要紧急甲状腺切除术。麻醉管理考虑因素包括HMGCR-M对呼吸肌的潜在影响以及需要仔细计划以减轻术后并发症。患者接受了甲状腺全切除术，左中央舱间隙,气管造口术.手术进展顺利，细致的监测和调整麻醉剂，以保持血流动力学稳定。术后,病人恢复得很好,在3个月的随访中显示神经系统症状完全缓解.该病例强调了在甲状腺手术中识别副肿瘤综合征的重要性，并强调了麻醉医师面临的潜在挑战。尽管HMGCR-M坏死性肌病的麻醉药物缺乏既定的安全性数据，该案例证明了七氟醚和罗库溴铵的成功使用。
