[Sevoflurane anesthesia for a patient with facioscapulohumeral muscle dystrophy]

We gave anesthesia to a patient with facioscapulohumeral muscle distrophy (FSHMD). Patient was an 18 year old male, having no peculiar complaint and without family history nor past history relating to FSHMD. The restriction of right arm lifting was pointed out in medical examination. Diagnosis of FSHMD was made by muscle biopsy. The thoraco-scapula fixation was scheduled. Four hours prior to the induction, dantrolene 50 mg was administered per os. Before the induction, to estimate the effect of neuromuscular blockade, we applied Datex Relaxograph to the upper and lower extremities. Anesthesia was induced with thiamylal 200 mg and vecuronium 4 mg, and maintained with sevoflurane and nitrous oxide monitoring ETCO2. The time for the onset of muscular relaxation after the administration of vecuronium was quite different between upper and lower extremities (200 sec. and 407 sec.). Neostigmine and atropine for the reversal of neuromuscular blockade was administered evaluating the extent of neuromuscular relaxation obtained from Datex Relaxograph. We concluded that Relaxograph is essential as a monitor of muscular relaxation, especially in the case of neuromuscular disease.