%0 Case Reports
%T Acute cricopharyngeal achalasia after general anesthesia in myotonic dystrophy: A case report.
%A Rho Y
%A Chon J
%A Yoo MC
%A Shim GY
%A Chung SJ
%A Soh Y
%J Medicine (Baltimore)
%V 102
%N 48
%D 2023 Dec 1
%M 38050269
%F 1.817
%R 10.1097/MD.0000000000036378
%X <B>BACKGROUND: </B>Myotonic dystrophy type 1 (DM-1) is a progressive multisystem genetic disorder that causes myotonia and both distal limb and facial/neck muscle weakness by expanding the CTG repeats of the DMPK gene in chromosome 19q13.3. General anesthesia is indicated in DM-1 patients owing to their sensitivity to anesthetic drugs such as opioids, hypnotics, and neuromuscular blocking agents.<BR><B>METHODS: </B>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.<BR><B>METHODS: </B>Acute cricopharyngeal achalasia after general anesthesia.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Low body temperature and anesthetic medications such as opioids and hypnotic agents can induce myotonia in the cricopharyngeal muscle.