A Safe Anesthetic Method Using Caudal Block and Ketamine for the Child with Congenital Myotonic Dystrophy

Abstract

To the Editor: A recent report on perioperative complications after general anesthesia in patients with myotonic dystrophy (DM) pointed out increased risk of perioperative pulmonary complications and severe muscular disability (1). We report the anesthetic management for a 2-yr-old boy with congenital DM using caudal block under ketamine sedation. The patient was scheduled for extension of the Achilles tendon. Ketamine (15 mg) was administrated IV. Then caudal block was performed and lidocaine (1%, 10 mL) was injected into the epidural space. After a 60-min operation, the patient recovered smoothly from anesthesia and the postoperative course was uneventful. We did not use inhaled anesthetics or neuromuscular relaxants, which may cause respiratory or circulatory depression. Tobias reported the epidural anesthesia for DM (2), and a recent report showed that a successful anesthetic technique using propofol and fentanyl in young DM patients (3). In general, it is difficult to perform caudal block for children without anesthesia, and safety of propofol is still unclear for children. However, in this case, sedation with ketamine was useful for the procedure of caudal block and during surgery. The anesthesia using caudal block under sedation by ketamine would be a safe method for the anesthesia of children with this disease. Munehiro Shiraishi, MD Kouichiro Minami, MD Tatsuo Kadaya, MD