Reactions 1680, p313 - 2 Dec 2017 Worsening of chronic inflammatory demyelinating polyradiculoneuropathy: 3 case reports In a retrospective study, 2 women and a man, aged between 46-73 years, experienced worsening of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) following administration of suxamethonium chloride [Succinylcholine; routes and dosages not stated] during general anaesthesia. A 46-year-old woman developed worsening of CIDP symptoms following administration of suxamethonium chloride during general anaesthesia. She had a 27-year history of CIDP. She had a modified Rankin Scale of 2 and Hendrich II Fall Risk Model score of 3. She underwent a hysterectomy which was robot assisted. The operation was performed with anaesthesia given via endotracheal route. To facilitate the endotracheal intubation, she was given suxamethonium chloride. Immediately after the operation, she experienced worsening of CIDP symptoms. While using the walker, she required assistance as her leg weakness exacerbated. The woman’s weakness improved within three days. A 73-year-old man developed worsening of CIDP symptoms following administration of suxamethonium chloride during general anaesthesia. The man had a 5-year history of CIDP. He had a Hendrich II Fall Risk Model score of 2 and modified Rankin Scale of 2. He had been taking prednisone daily. He had paraesthesias in both the lower extremities. He underwent an open heart surgery, during which he received suxamethonium chloride. Several months after the operation, he experienced worsening of CIDP symptoms. This led to an increase in his prednisone dose [outcome not stated]. A 70-year-old woman developed worsening of CIDP symptoms following administration of suxamethonium chloride during general anaesthesia. She had a 14-year history of CIDP. She was being treated with IV immune globulin. Several months prior to surgery, her condition started deteriorating. Six months prior to the surgery, she was wheelchair bound, but was able to ambulate independently for thirty minutes. Two weeks prior to surgery, she was bed bound. She had metastatic cervical cancer. She developed colon perforation, and presented for an exploratory laparotomy of colon. During the laparotomy she received suxamethonium chloride. Postoperatively, she required mechanical ventilation for 10 hours. She had worsening weakness and adynamic ileus. She refused further treatment and was transitioned to a palliative course in the setting of metastatic cancer and general debility (in part from her CIDP). She died from malnutrition 46 days after her operation. Author comment: "Although our patients tolerated neuromuscular drugs, substantial theoretical concerns with these medications in patients with demyelinating neuropathies preclude safety in this population without further study.""CIDP patients may be at risk for worsening symptoms of their disease after general anaesthesia or surgical procedure,or both." Mortenson AR, et al. Chronic inflammatory demyelinating polyradiculoneuropathy and anesthesia: a case series. Acta Neurologica Belgica 117: 895-901, No. 4, Dec 2017. Available from: URL: http://doi.org/10.1007/s13760-017-0836-1 - USA 803285617 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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