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Tsuboi E, Azuma Y, Makino T, Terada T, Otsuka H, Sano A, Koezuka S, Sakai T, Tochigi N, Iyoda A. Mediastinal tumor resection in a patient with spinocerebellar degeneration. J Cardiothorac Surg 2020; 15:197. [PMID: 32727532 PMCID: PMC7389681 DOI: 10.1186/s13019-020-01218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background In spinocerebellar degeneration (SCD) patients, general and regional anesthesia may cause postoperative dysfunction of respiratory, nerve and muscle systems. We present the surgical case of thymoma developed in patient with SCD. Case presentation A 47-year-old woman with spinocerebellar degeneration was admitted because of a well-defined mass measuring 48 × 31 mm in anterior mediastinum. She showed limb, truncal, ocular, and speech ataxia; hypotonia; areflexia; sensory disturbances; and muscle weakness. Her eastern cooperative oncology group performance status was 4. Surgical resection was performed via video-assisted thoracic surgery and under general anesthesia only without epidural analgesia. The mass was diagnosed as type B1 thymoma without capsular invasion (Masaoka stage I). The patients got a good postoperative course by cooperation with anesthesiologists and neurologists in perioperative managements. She has been well over 3 years of follow-up. Conclusions In conclusion, careful surgical and anesthesia management is essential for providing an uneventful postoperative course in patients with SCD. Especially, selection of minimal invasive approach and avoid diaphragmatic nerve damage are the most important points in surgical procedures.
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Affiliation(s)
- Eiyu Tsuboi
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Makino
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Terada
- Department of Anesthesiology, Toho University School of Medicine, Tokyo, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
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Aldawoodi NN, Escher Jr. AR, Padalia A, Padalia D. Sentinel Node Biopsy and Lumpectomy in a Patient with Machado-Joseph Disease. Case Rep Anesthesiol 2019; 2019:2309598. [PMID: 31934455 PMCID: PMC6942782 DOI: 10.1155/2019/2309598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/25/2019] [Indexed: 11/24/2022] Open
Abstract
Spinocerebellar ataxia 3 (SCA3), also known as Machado-Joseph disease (MJD) is an autosomal dominant, progressive neurodegenerative disorder. Patients present with cerebellar ataxia, dystonia, rigidity, and neuropathy that worsen with time. On a molecular level, it occurs due to a CAG trinucleotide repeat expansion in the ATXN3 gene. Due to the risk of pulmonary aspiration, hypoventilation, autonomic and thermoregulatory dysfunction, vocal cord paralysis, progressive paraplegia, parkinsonian symptoms, and chronic pain, it has significant anesthesia implications. Rarely, case reports occur in the literature describing regional anesthetic management of patients with SCA3, but none that describe general anesthesia specifically with MJD. We therefore describe a case of a patient with SCA3 who successfully underwent general anesthesia and considerations for perioperative management of this patient population.
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Affiliation(s)
- N. N. Aldawoodi
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A. R. Escher Jr.
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A. Padalia
- Neurology, Barnes Jewish Hospital, St. Louis, MO, USA
| | - D. Padalia
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Vadhanan P, Kumar P. Anesthetic management of a patient with spinocerebellar degeneration. J Anaesthesiol Clin Pharmacol 2013; 27:249-52. [PMID: 21772692 PMCID: PMC3127311 DOI: 10.4103/0970-9185.81834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spinocerebellar degeneration or olivopontocerebellar degeneration denotes a group of disorders of various etiologies manifesting as degenerative changes of various part of the central nervous system. We describe the anesthetic management of a patient with severe olivopontocerebellar degeneration posted for vaginal hysterectomy. A combined spinal epidural technique was performed at the level of L2-L3. The anesthetic implications of the various aspects of spinocerebellar degeneration are discussed.
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Affiliation(s)
- Prasanna Vadhanan
- Department of Anesthesia, Vinayaka Missions Medical College, Karaikal, India
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Kang JM, Chung JY, Han JH, Kim YS, Lee BJ, Yi JW. Anesthetic management of a patient with Huntington's chorea -A case report-. Korean J Anesthesiol 2013; 64:262-4. [PMID: 23560194 PMCID: PMC3611078 DOI: 10.4097/kjae.2013.64.3.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 11/21/2022] Open
Abstract
Huntington's chorea is a rare hereditary disorder of the nervous system. It is inherited as an autosomal dominant disorder and is characterized by progressive chorea, dementia and psychiatric disturbances. The best anesthetic technique is yet to be established for these patients with increased risk of aspiration due to involvement of pharyngeal muscles and an exaggerated response to sodium thiopental and succinylcholine. The primary goal in general anesthesia for these patients is to provide airway protection and a rapid and safe recovery. We report the anesthetic management of a 51-year-old patient with Huntington's chorea admitted for an emergency operation.
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Affiliation(s)
- Jong-Man Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Kivela JE, Sprung J, Southorn PA, Watson JC, Weingarten TN. Anesthetic management of patients with Huntington disease. Anesth Analg 2010; 110:515-23. [PMID: 20081136 DOI: 10.1213/ane.0b013e3181c88fcd] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Huntington disease (HD) is a rare autosomal dominant disease with symptoms of chorea, dystonia, incoordination, cognitive decline, and behavioral difficulties. Abnormal responses to anesthesia have been reported in case reports and raised concerns regarding the safety of anesthesia in this patient population. METHODS We performed a computerized search of the Mayo Clinic medical records database searching for patients with HD who underwent general anesthesia. Medical records were reviewed for anesthetic technique, medications used, and postoperative complications. RESULTS We identified 11 patients with genetically confirmed HD who underwent 17 general anesthetics. Psychiatric medication use was common, with 6 patients using antipsychotics, 7 patients using antidepressants, and 3 patients using benzodiazepines. Succinylcholine was used in 7 anesthetics, and nondepolarizing neuromuscular blocking drugs in 11 anesthetics, all without adverse effects. Patients had normal responses to induction and maintenance of anesthesia without adverse effects. Serious postoperative complications did not occur. CONCLUSION Contrary to previous case reports, we found that patients with HD have normal responses to general anesthesia. However, the anesthesiologist should be aware of interactions between anesthetics and psychiatric medications frequently used by these patients. Measures should also be taken to minimize the risk of pulmonary aspiration because bulbar dysfunction may be a manifestation of this disease.
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Affiliation(s)
- Jonathon E Kivela
- Departments of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Rofaeel A, Balki M, Carvalho JCA. Case report: Successful labour epidural analgesia in a patient with spinocerebellar ataxia. Can J Anaesth 2007; 54:467-70. [PMID: 17541076 DOI: 10.1007/bf03022033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report the favourable outcome associated with epidural analgesia in a parturient with spinocerebellar ataxia (SCA). CLINICAL FEATURES A 34-yr-old patient, G2 P0, presented at term with a history of SCA since the age of 22 characterized by slurred speech, balance and gait disturbances, diplopia and nystagmus. A magnetic resonance imaging of the brain at the age of 27 showed cerebellar degeneration. Neurological examination revealed an unsteady, wide-based gait, nystagmus, mild dysarthria, moderate finger to nose ataxia, absent reflexes in all upper and lower limbs, sensory loss to vibration and temperature discrimination up to the level of both knees, and normal motor strength. The patient presented for induction of labour at 40 weeks and requested epidural analgesia, which was performed in the usual manner. Following a negative test dose of 3 mL of 2% lidocaine, a loading dose of 10 mL of 0.125% bupivacaine was administered, and maintenance of analgesia was achieved with a mixture of bupivacaine 0.0625% and fentanyl 2 microg.mL(-1). The patient required standard doses of the epidural mixture, and experienced effective analgesia for labour and delivery. Her recovery was uneventful and no subsequent neurological deficit was detected up to two years after delivery. CONCLUSIONS Neurological disorders may contraindicate regional anesthesia, and the decision to proceed with a regional technique should be based on the pathophysiology and severity of each particular case. Uneventful epidural analgesia was provided to a parturient with SCA, with no long term effects detected up to two years after delivery.
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Affiliation(s)
- Ayman Rofaeel
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Avenue, Room 781, Toronto, Ontario M5G 1X5, Canada
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Tsen LC, Smith TJ, Camann WR. Anesthetic Management of a Parturient with Olivopontocerebellar Degeneration. Anesth Analg 1997. [DOI: 10.1213/00000539-199711000-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tsen LC, Smith TJ, Camann WR. Anesthetic management of a parturient with olivopontocerebellar degeneration. Anesth Analg 1997; 85:1071-3. [PMID: 9356102 DOI: 10.1097/00000539-199711000-00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L C Tsen
- Department of Anesthesia, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Kotani N, Hirota K, Anzawa N, Takamura K, Sakai T, Matsuki A. Motor and Sensory Disability Has a Strong Relationship to Induction Dose of Thiopental in Patients with the Hypertropic Variety of Charcot-Marie-Tooth Syndrome. Anesth Analg 1996. [DOI: 10.1213/00000539-199601000-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kotani N, Hirota K, Anzawa N, Takamura K, Sakai T, Matsuki A. Motor and sensory disability has a strong relationship to induction dose of thiopental in patients with the hypertropic variety of Charcot-Marie-Tooth syndrome. Anesth Analg 1996; 82:182-6. [PMID: 8712399 DOI: 10.1097/00000539-199601000-00034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In a prospective study, we determined the anesthetic induction dose of thiopental and the clinical variables influencing the appropriate induction dose of thiopental in 20 patients with the hypertrophic variety of Charcot-Marie-Tooth syndrome (CMT). As controls we chose 50 patients without CMT. Motor disturbance was evaluated in terms of muscle weakness of the distal lower and upper extremities. We examined sensory disturbance by evaluating loss of sensation in the index finger and great toe. The preinduction cardiac output was measured by echocardiography. Anesthesia was induced with repeated injections of 50 mg thiopental. The minimum induction dose of thiopental (MID) was confirmed when the eyelash reflex ceased. We maintained anesthesia with enflurane and nitrous oxide. The 95% confidence interval of the MID in patients used as the controls was 2.5-4.9 mg/kg. The MID in 11 patients with CMT was less than 2.5 mg/kg. MIDs in the patients with CMT were significantly smaller than those of the control patients (P < 0.0001). Also we found a strong relationship between the MID and the severity of both motor and sensory disturbances (P = 0.003 and 0.002, respectively). There was no relationship between the MID and other clinical variables, such as age, gender, inherited type, body weight, and preinduction cardiac output. Because delay in the recovery from anesthesia can be caused by an inappropriate dose of thiopental in CMT patients in whom motor and sensory function is seriously impaired, the dose of thiopental probably should be reduced and based on the individual patient's response.
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Affiliation(s)
- N Kotani
- Department of Anesthesiology, University of Hirosaki School of Medicine, Japan
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