强直性肌营养不良(肌营养不良症;DM)是一种罕见的进行性遗传性肌肉疾病,在出生时可表现出不同的严重程度,在儿童早期,或者最常见的是成年人。DM患者,特别是类型1(DM1),对镇静催眠药的呼吸抑制作用极其敏感,抗焦虑药,和阿片类激动剂。该病例报告描述了一名37岁的男性患者,先前未诊断为DM1,他在使用静脉注射咪达唑仑的最低程度镇静下接受了牙科护理。在案件中,患者经历了2次短暂的低氧血症发作,其中第二种需要在丙泊酚和琥珀酰胆碱之后进行紧急插管,并导致住院时间延长.在最后一次局部麻醉剂注射后大约2小时,由于轻微的ST升高和怀疑局部麻醉剂毒性(LAST),给予脂质乳剂(LiposynII20%)输注。治疗后几个月,病人跌倒导致致命的创伤性脑损伤。在此病例报告中指出的并发症主要归因于DM1的未知诊断,尽管可能存在其他诱发因素。本报告还提供了对强直性肌营养不良患者进行局部麻醉牙科护理的文献和临床指南的基本回顾。镇静,或全身麻醉。
Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This
case report describes a 37-year-old male patient with previously undiagnosed DM1 who received dental care under minimal sedation using intravenous midazolam. During the
case, the patient experienced 2 brief episodes of hypoxemia, the second of which required emergency intubation after propofol and succinylcholine and resulted in extended hospital admission. A lipid emulsion (Liposyn II 20%) infusion was given approximately 2 hours after the last local anesthetic injection due to slight ST elevation and suspicion of local anesthetic toxicity (LAST). Months after treatment, the patient suffered a fall resulting in a fatal traumatic brain injury. Complications noted in this
case report were primarily attributed to the unknown diagnosis of DM1, although additional precipitating factors were likely present. This report also provides a basic review of the literature and clinical guidelines for managing myotonic dystrophy patients for dental care with local anesthesia, sedation, or general anesthesia.