Abstract
BackgroundIsaacs’ syndrome is a peripheral nerve hyperexcitability syndrome and rare acquired channel disease. The symptoms (myokymia, neuromyotonia, and muscle spasm) emerge even during sleep. This report describes the anesthetic management, especially neuromuscular blocking drugs and postoperative pain, in a case of Isaacs’ syndrome.Case presentationA 63-year-old woman with Isaacs’ syndrome underwent elective laparoscopic distal gastrectomy under general anesthesia without epidural anesthesia. She received double filtration plasmapheresis four times to alleviate symptoms before surgery. To avoid a prolonged neuromuscular blockade, we performed total intravenous anesthesia and titrated muscle relaxant with neuromuscular monitoring. Anesthetic management was performed without any problems. However, pain management after surgery proved difficult as she experienced severe pain due to myokymia.ConclusionsDespite attempts to minimize symptoms, severe postoperative pain associated with myokymia occurred. Continuous regional anesthesia should be considered to treat pain from abnormal discharge in the central nervous system in Isaacs’ syndrome.
Highlights
Isaacs’ syndrome is a peripheral nerve hyperexcitability syndrome and rare acquired channel disease
Despite attempts to minimize symptoms, severe postoperative pain associated with myokymia occurred
Subsequent to confirming stable vital signs and neuromuscular symptoms after extubation, the patient was moved to an intensive care unit. She complained about abdominal pain, so the infusion rate of fentanyl was increased to 1.0 μg/ kg/h, and dexmedetomidine (0.4 μg/kg/h) was added to control pain. She was discharged to the general ward the day after surgery; the abdominal pain worsened because myokymia frequently occurs in the rectus abdominis muscle
Summary
Despite attempts to minimize symptoms, severe postoperative pain associated with myokymia occurred.
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