The Rusch Flexi-Slip stylet for ProSeal laryngeal mask airway insertion.

CAN J ANESTH 55: 10 www.cja-jca.org October, 2008 ing drugs (NMBDs). Anesthesia was maintained with desflurane in oxygen, and her trachea was extubated at the end of the procedure without incident. Save for a prolonged duration of analgesia lasting approximately 30 hr, telephone follow-up revealed that the patient’s recovery was unremarkable with eventual complete resolution. Traditionally, due to concern about local anesthetic toxicity on the demyelinated nerve, anesthesia options for patients with CMT have been limited to general anesthesia. However, a recent retrospective review,1 which included patients with multiple sclerosis, did not demonstrate an increase in adverse outcomes. If the disease is progressing in CMT patients, the use of depolarizing NMBDs may cause hyperkalemia, and CMT patients may be sensitive to non-depolarizing agents; however, Antognini2 reports the safe use of succinylcholine in CMT patients. Other authors report sensitivity to non-depolarizing NMBDs.3 Patients with OSA can be sensitive to opiods used for postoperative analgesia, as can CMT patients.2 Minimizing the use of opiods is reasonable in patients with significant COPD and OSA. Interestingly, the duration of the block (about 30 hr by patient report) was longer than expected. Other authors have reported prolonged duration of epidural anesthesia, but not spinal, in patients with CMT.4 Also, there were no resulting complications from using general anesthesia in our patient. However, according to reah et al.,5 if general anesthesia is used in patients with CMT, postoperative ventilation is likely to be required. This requirement could possibly be secondary to the fact that reah et al. patients were pregnant, a condition known to exacerbate CMT. The use of a peripheral nerve block, in this patient with CMT, OSA, and morbid obesity, spared excessive postoperative use of opioid analgesics. Also, providing optimal analgesia enhanced our ability to manage her successfully as an outpatient. review of the available literature failed to show a link between CMT and adverse neurologic outcomes, albeit with a very small number of patients reported. Lacking evidence to the contrary, we believe that peripheral nerve blocks should be considered as an option in the anesthetic care of patients with CMT.