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Anesth Analg 2002;94:233
© 2002 International Anesthesia Research Society

LETTERS TO THE EDITOR

A Safe Anesthetic Method Using Caudal Block and Ketamine for the Child with Congenital Myotonic Dystrophy

Munehiro Shiraishi, MD, Kouichiro Minami, MD, and Tatsuo Kadaya, MD

Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan Department of Anesthesia, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan

To the Editor:

A recent report on perioperative complications after general anesthesia in patients with myotonic dystrophy (DM) pointed out increased risk of perioperative pulmonary complications and severe muscular disability (1). We report the anesthetic management for a 2-yr-old boy with congenital DM using caudal block under ketamine sedation. The patient was scheduled for extension of the Achilles tendon. Ketamine (15 mg) was administrated IV. Then caudal block was performed and lidocaine (1%, 10 mL) was injected into the epidural space. After a 60-min operation, the patient recovered smoothly from anesthesia and the postoperative course was uneventful. We did not use inhaled anesthetics or neuromuscular relaxants, which may cause respiratory or circulatory depression. Tobias reported the epidural anesthesia for DM (2), and a recent report showed that a successful anesthetic technique using propofol and fentanyl in young DM patients (3). In general, it is difficult to perform caudal block for children without anesthesia, and safety of propofol is still unclear for children. However, in this case, sedation with ketamine was useful for the procedure of caudal block and during surgery. The anesthesia using caudal block under sedation by ketamine would be a safe method for the anesthesia of children with this disease.

References

  1. Mathieu J, Allard P, Gobeil G, et al. Anesthetic and surgical complications in 219 cases of myotonic dystrophy. Neurology 1997; 49: 1646–50.[Abstract/Free Full Text]
  2. Tobias JD. Anaesthetic management of the child with myotonic dystrophy: epidural anaesthesia as an alternative to general anaesthesia. Paediatr Anaesth 1995; 5: 335–8.[Medline]
  3. Bennun M, Goldstein B, Finkelstein Y, Jedeikin R. Continuous propofol anaesthesia for patients with myotonic dystrophy. Br J Anaesth 2000; 85: 407–9.[Abstract/Free Full Text]




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2002 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press