Anesthetic management of a patient combining myotonic dystrophy and obesity

We describe the anesthetic management of an obese myotonic patient who underwent bilio-pancreatic diversion for severe obesity. A female, 35 years old (weight 137 kg, height 160 cm, excess body weight 120%) suffered from myotonic dystrophy and obesity, complicated by a mild heart failure and restrictive disease. Induction of anesthesia and tracheal intubation were performed after propofol (1 mg/kg). Anesthesia was maintained with isoflurane and fentanyl muscular blockade by vecuronium bromide. Perioperatively extensive hemodynamic monitoring has been performed. The patient was discharged successfully the 12th day postoperatively. One year later she had lost 50 kgs of body weight; oxygen blood tension and pulmonary function tests were greatly improved.