Anesth Analg 2006;103:1596
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000246267.37723.e3
LETTER TO THE EDITOR
Editor-in-Chief Steven L. Shafer
Tramadol, Vecuronium, and Thoracic Epidural Ropivacaine Combined with Sevoflurane Anesthesia in a Patient with Human T-Lymphotropic Virus Type 1-Associated Myelopathy
Kazuhisa Sugimoto, MD,
Aki Ohmori, MD,
Hiroshi Iranami, MD, and
Yoshio Hatano, MD
Department of Anesthesiology; Japanese Red Cross Society of Wakayama Medical Center; ikkyu{at}qj8.so-net.ne.jp (Sugimoto, Ohmori, Iranami)
Department of Anesthesiology; Wakayama Medical University; Wakayama City; Wakayama 641-0012, Japan (Hatano)
To the Editor:
We describe two experiences with general anesthesia in a 73-year-old male patient with human T-lymphotropic virus type 1 (HTLV-1) associated myelopathy (HAM) with spinal degeneration at the conus. The first anesthetic was for video-assisted pulmonary bullectomy. After placement of a thoracic epidural catheter, general anesthesia was induced with sevoflurane and nitrous oxide. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg. General anesthesia was maintained with sevoflurane and nitrous oxide, as well as continuous thoracic epidural infusion of 0.75% ropivacaine at 5 mL/h. The second surgery was for transuretheral resection of the prostate. The patient received tramadol 2 mg/kg before induction of anesthesia. Anesthesia was induced and maintained with sevoflurane and nitrous oxide. These cases were remarkable for the lack of any neurological deterioration, evidence of abnormal duration of vecronium effect, or unusual response to tramadol.
HAM results in spinal lesions typically at the middle and lower thoracic spinal cord, where myelin and axonal degeneration is caused by inflammatory infiltrations (mainly T lymphocytes) (1). HAM may render the spinal cord susceptible to injury after neuraxial anesthesia (2,3). On the other hand, bupivacaine may be neuroprotective, at least in rats (4). The lack of neurological sequelae in our patient suggests that thoracic epidural block with ropivacaine is a reasonable option in such patients. It remains unknown whether neuromuscular junctions of HAM are pathological or not. Our first case did not demonstrate abnormal duration of vecronium’s effect, as also shown in an earlier report (5). The sensitivities of myelopathic patients to tramadol, a mu-opioid receptor agonist with mixed pharmacology, are unknown. In this case tramadol did not cause any adverse effects.
There are very limited data about anesthetic options in patients with HAM (5,6). This case contributes several additional data points to this scant literature.
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