Anesthetic management for pancreaticoduodenectomy in a patient with CMT

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Masui. 2009 Oct;58(10):1313-5.

Anesthetic management for pancreaticoduodenectomy in a patient with

Charcot-Marie-Tooth disease and liver cirrhosis

Hashimoto T, Morita M, Hamaguchi S, Kitajima T.

Department of Anesthesiology, Dokkyo Medical University Hospital, Tochigi

321-0293.

A 68-year-old man was scheduled for pancreaticoduodenectomy under general

anesthesia. He was suffering from Charcot-Marie-Tooth disease (CMTD) for 34

years, and complicated with liver cirrhosis. Anesthesia was induced with

propofol and fentanyl, and maintained with oxygen-air-sevoflurane and

remifentanil. Epidural block was not used because the patient had coagulation

abnormality and thrombocytopia. Rocuronium was injected intravenously for

tracheal intubation, supplemented as required using an electrical nerve

stimulator. The longer duration of action of rocuronium was observed in this

case because the patient was complicated with CMTD and liver cirrhosis. We

suggest that monitoring neuromuscular function may be necessary to detect subtle

residual neuromuscular blockade when rocuronium is used in a patient with CMTD

and liver dysfunction.