Anesthesia Considerations 

Polymyositis & Dermatomyositis 

 

 

Background 

 

• Idiopathic inflammatory myopathies characterized by proximal skeletal muscle weakness & evidence of muscle inflammation 

• Dermatomyositis but not polymyositis is associated with a variety of characteristic skin manifestations

 

 

Considerations

 

• Potential difficult airway (restricted temporomandubular joint & cervical spine mobility) 

• Aspiration risk (esophageal dysfunction) 

• Respiratory:

  • Interstitial lung disease, pulmonary fibrosis  

  • Potential postoperative respiratory muscle failure & need for ventilation

• Cardiovascular:

  • Myocardial fibrosis, myocarditis, conduction defects, arrhythmias 

• Altered response to succinylcholine (theorectical hyperkalemia) & possible sensitivity to NdMRs (nondepolarizing muscle relaxants):

  • Avoid succinylcholine, consider ↓ rocuronium dose 

• Treatment: steroids, immunosuppressants, IVIG, monoclonal antibodies

 

 

Conflicts

• RSI for aspiration risk vs. difficult intubation

• RSI for aspiration risk vs. avoid succinylcholine 

• RSI for aspiration risk vs. cardiac induction

 

 

Pregnancy Considerations 

 

• Avoid succinylcholine if RSI for general anesthesia

• Caution with neuraxial if already compromised respiratory muscles