Anaesthetic problems

1. Dermatomyositis is associated with an increased incidence of malignancy (Richardson & Callen 1989, Sigurgeirsson et al 1992).

2. Prolonged neuromuscular blockade after vecuronium has been reported (Flusche et al 1987), but the reason for this is obscure since an inflammatory myopathy should not affect the neuromuscular junction. However, neuromuscular monitoring in two patients receiving atracurium (Ganta et al 1988), one having vecuronium (Saarnivaara 1988), and another having both suxamethonium and atracurium (Brown et al 1992), did not suggest sensitivity. However, one child had an abnormal response to suxamethonium. Before muscle relaxation occurred, fasciculations were followed by a short period of muscle contraction (Johns et al 1986). Nevertheless, marked increases in muscle tone following suxamethonium may occur in some normal patients, so the significance of this is uncertain (Leary & Ellis 1990).

3. Swallowing and vocal cord dysfunction may cause pooling of secretions and aspiration of gastric contents (Metheny 1978).

4. Aspiration pneumonia is the commonest pulmonary problem and postoperative respiratory insufficiency may occur.

5. Dermatomyositis presented in the first trimester with a painful, inflammatory myopathy, rhabdomyolysis (CK 3974 u l-1), and fetal loss (Kofteridis et al 1999).

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