Neuromuscular monitoring of a patient with Charcot-Marie-Tooth disease; which monitoring technique is adequate? - A case report and literature review.

Anesthesia and pain medicine Pub Date : 2024-01-01 Epub Date: 2024-01-30 DOI:10.17085/apm.23111

Seung Un Kim, Seora Kim, Ki Tae Jung

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Abstract

Background: Charcot-Marie-Tooth disease (CMTD) is a hereditary polyneuropathy associated with a life-threatening risk of pulmonary complications.

Case: A 61-year-old male with CMTD for 40 years was admitted for the drainage of an abscess in his left ankle. Total intravenous anesthesia was administered, and an electromyography device was attached to the hand for neuromuscular monitoring; however, the response was not measured. Kinemyography and acceleromyography devices were attached to both hands, and responses were obtained. After neuromuscular blockade (NMB) with rocuronium 0.6 mg/kg, the train-of-four (TOF) response on kinemyography was normally measured, but the post-tetanic count on acceleromyography consistently showed 0 during anesthesia. Sugammadex 200 mg was injected to reverse the NMB. After 5 min, the TOF ratios for kinemyography and acceleromyography exceeded 90%. The patient recovered without any complications.

Conclusions: For CMTD patients, acceleromyography or kinemyography is superior to electromyography, and sugammadex can be used to reverse NMB successfully.

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对 Charcot-Marie-Tooth 病患者进行神经肌肉监测；哪种监测技术合适？- 病例报告和文献综述。

背景：Charcot-Marie-Tooth 病（CMTD）是一种遗传性多发性神经病，有肺部并发症的危险，危及生命：一名患有 CMTD 40 年的 61 岁男性患者因左脚踝脓肿引流而入院。对他进行了全静脉麻醉，并在他的手部安装了肌电图设备，用于神经肌肉监测；但是没有测到反应。在双手上安装了运动肌电图和加速肌电图装置，并获得了反应。在使用 0.6 毫克/千克罗库溴铵进行神经肌肉阻滞（NMB）后，可以正常测量到运动肌电图上的四次火车（TOF）反应，但在麻醉期间，加速肌电图上的四次火车后计数一直显示为 0。注射了 200 毫克舒格迈司以逆转 NMB。5 分钟后，运动肌电图和加速肌电图的 TOF 比率超过了 90%。患者康复后未出现任何并发症：结论：对于 CMTD 患者，加速肌电图或运动肌电图优于肌电图，而且苏麦德可成功逆转 NMB。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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