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[Anesthesia for pneumothorax surgery in a patient with type II chronic respiratory failure associated with inclusion body myositis].
[inclusion body myositis]
A
40
-
year
-old
man
was
scheduled
for
video
assisted
thoracoscopic
surgery
due
to
pneumothorax
.
He
had
been
diagnosed
with
inclusion
body
myositis
and
received
nocturnal
non-invasive
positive
pressure
ventilation
.
Anesthesia
was
induced
with
propofol
,
remifentanil
,
and
rocuronium
,
and
maintained
with
propofol
,
remifentanil
and
fentanyl
.
The
dosage
of
rocuronium
was
10
mg
.
Although
we
administered
neostigmine
at
the
end
of
the
operation
and
TOF
ratio
was
over
90
%
,
he
was
transported
to
the
ICU
with
tracheal
intubation
because
of
poor
spontaneous
respiration
.
On
POD
1
,
the
tracheal
tube
was
extubated
and
NPPV
was
administered
again
.
Minitrach
was
inserted
on
POD
2
,
and
he
left
the
ICU
on
POD
4
.
Generally
,
in
patients
with
myopathy
the
dose
of
muscle
relaxant
should
be
decreased
in
proportion
to
their
muscle
atrophy
.
Rocuronium
10
mg
was
administered
in
this
case
and
we
thought
it
could
be
antagonized
by
neostigmine
,
but
extubation
on
the
day
of
operation
was
impossible
.
We
think
this
is
not
because
of
the
residual
effect
of
muscle
relaxant
,
but
because
of
decreases
in
pulmonary
function
.
In
this
case
,
we
expected
long
-term
mechanical
ventilation
might
be
necessary
,
but
he
showed
a
good
postoperative
course
owing
to
minimally
invasive
surgery
,
NPPV
,
and
suctioning
of
sputum
via
Minitrach
.
Diseases
Validation
Diseases presenting
"poor spontaneous respiration"
symptom
inclusion body myositis
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