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LETTER TO EDITOR
Year : 2012 | Volume
: 6
| Issue : 4 | Page : 435
Role of subarachnoid block in patient with dermatomyositis
Sachidanand J Bharati1, Tumul Chowdhury2
1 Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
2 Medanta The Medicity Hospital, Gurgaon, India
Correspondence Address:
Sachidanand J Bharati
Department of Anesthesiology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi - 110029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-354X.105904
| Date of Web Publication | 10-Jan-2013 |
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How to cite this article:
Bharati SJ, Chowdhury T. Role of subarachnoid block in patient with dermatomyositis. Saudi J Anaesth 2012;6:435 |
Sir,
Dermatomyositis is a rare idiopathic inflammatory myopathy (9.63 cases per million populations) and associated with various extra muscular manifestations such as pulmonary dysfunction due to thoracic muscle weakness and cardiac disturbances such as atrioventricular conduction defects, congestive heart failure, and myocarditis. [1] Most of the cases reported emphasize only the role of general anesthesia (with or without muscle relaxant technique); however, the literature is scant and limited about role of regional anesthesia in such cases. We have highlighted the successful regional anesthetic management in such case.
A 46 year-old-male patient, diagnosed case of dermatomyositis, was scheduled for biopsy of a mass on the right buttock. He had no history of dysphasia or any respiratory problem and there was no other systemic involvement. His hemogram, biochemical parameters, and 2D-ECHO were within normal limits. His sensory system was intact. EMG was suggestive of myopathy. On the pre-operative night, he was given 40 mg pantaperazole. Since the surgical site was right buttock, so it was planned to administer regional anesthesia. Routine monitors were attached and back was prepared with povidone−iodine solution. We gave 12.5 mg of hyperbaric bupivacaine with 25 mcg of fentanyl intrathecal in the L4-L5 interspace in right lateral position wit 30 G spinal needle. Sensory level was checked after 10 min of the block and found to be attained the level of T10 segment. After the drug level was fixed, patient was made left lateral. Surgery went for 75 min. Intraoperative vitals remained stable throughout the surgery. Patient was shifted to postoperative recovery unit. After 6 h postoperatively, patient regained his preoperative limb power and discharged next day.
Inflammatory myopathies impose many concerns for the anesthesiologist like aspiration, arrhythmias, cardiac failure, delayed recovery from muscle relaxation, and steroid supplementation with its complications. [2] The role of muscle relaxant is still controversial. [3],[4] The use of regional anesthesia specially subarachnoid block in these cases were never reported; however, use of epidural technique was highlighted by very few authors. [5] In view of large bore epidural needle (16 or 18 G) needle, more quantity of local anesthetic use and risk of dura puncture, we decided to give sub arachnoid block with the finest needle available. Especially in lower limb surgery, one should avoid general anesthesia due to its known complications in such cases. In conclusion, one may apply sub arachnoid block in selective patients with dermatomyositis and can minimize the complications associated with use of muscle relaxants and other anesthetics.
| References | |  |
| 1. | Dalakas MC. Polymyositis, dermatomyositis and inclusion body myositis. In: Isselbacher, Braunwald, Wilson et al. Harrison's principles of internal medicine. Mc Graw Hill; 2004. p. 2540-45. 
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| 2. | Fujita A, Okutani R, Fu K. Anesthetic management for colon resection in a patient with polymyositis. Masui 1996;45:334-36.
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| 3. | Ukei M, Tosaki Y, Ogli K, Uefuji T. Anesthetic management of a patient with dermatomyositis - clinical observation of the effect of muscle relaxants. Masui 1989;38:1505-8.
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| 4. | Flusche G, Unger-Sargon J, Lamdert DH. Prolonged neuromuscular paralysis with Vecuronium in a patient with polymyositis. Anesth Analg 1987;66:188-90.
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| 5. | Izuta S, Yaku H, Kiyonari Y, Maekawa N, Obara H. Anesthetic management of a patient with mitochondrial encephalomyopathy. Masui 2000;49:649-51.
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