Anesthetic management for pancreaticoduodenectomy in a patient with CMT and live

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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.