Indian Journal of Anaesthesia  
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CASE REPORT
Year : 2007  |  Volume : 51  |  Issue : 1  |  Page : 43-46

Anaesthetic Management for Laparoscopic Cholecystectomy in two patients with biopsy proven Polymyositis


1 M.D. Asso. Consultant, Department of Anaesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India
2 M.D., Jr. Consultant, Department of Anaesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India
3 D.N.B., Sr. Resident, Department of Anaesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India
4 M.D., FFARCS, PGDHHM, Sr. Consultant and Chairperson Department of Anaesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi - 110 060, India

Correspondence Address:
Shikha Sharma
D-195 Sushant Lok, Gurgaon -122002, Haryana
India
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Two patients aged 46 and 31 years with biopsy proven polymyositis presented for laparoscopic cholecystectomy. They gave history of fall while walking and difficulty in climbing stairs. There were clinical features of peripheral muscle weakness but no respiratory muscle involvement. They were being managed conservatively.Pre-operative investigations were within normal limits. They received no sedation preoperatively. Anaesthesia was induced with 1-1.5 mgkg-1 of propofol and ProSeal laryngeal mask airway was inserted under propofol anaesthesia in case 1 and after atracurium besylate 10 mg I.V. in case 2. Anaesthesia was maintained with a continuous infusion of propofol, bolus dose of fentanyl and nitrous oxide in oxygen. Bispectral index (BIS) was monitored and maintained between 40-60. Anaesthesia was reversed with neostigmine 2.5 mg and glycopyrrolate 0.4 mg. BIS values returned to pre-anaesthetic level of 80-90 after 5-10 min, suggesting that use of propofol, ProSeal Laryngeal Mask Airway and atracurium besylate with peripheral nerve monitoring can be a safe means of inducing and maintaining anaesthesia in patients with polymyositis.


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