Total Intravenous Anesthesia (TIVA) for Stiff-Person Syndrome

Fiore V. Toscano, Angela K.Vick, Hamilton H. Shay, Ellise S. Delphin

Departmentof Anesthesiology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, USA.

DOI: 10.4236/ojanes.2012.24042                

Abstract

Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.

Keywords

Stiff-Person Syndrome; Stiff-Man Syndrome; Total Intravenous Anesthesia (TIVA)

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. Lockman, T. M. Burns, “Neurological Rarity: StiffPerson Syndrome,” Practice Neurology, Vol. 7, No. 2, 2007, pp. 106-108.
[2]	R. Raju, G. Rakocevic, Z. Chen, et al., “Autoimmunity to GABAA-Receptor-Associated Protein in Stiff-Person Syndrome,” Brain, Vol. 129, No. 12, 2006, pp. 3270-3276. HUdoi:10.1093/brain/awl245U
[3]	L. M. Levy, M. C. Dalakas and M. K. Floeter, “The StiffPerson Syndrome: An autoimmune Disorder Affecting Neurotransmission of Gamma-Aminobutyric Acid,” Annals of Internal Medicine, Vol. 131, No. 7, 1999, pp. 522530.
[4]	M. Solimena, F. Folli, A. Roxanne, B. Pozza, P. De Camilli, “Autoantibodies to GABA-Ergic and Pancreatic Be-ta Cells in Stiff-Mann Syndrome,” The New England Journal of Medicine, Vol. 322, 1990, pp. 1555-1560. HUdoi:10.1056/NEJM199005313222202U
[5]	T. Ledowski and P. Russel, “Anaesthesia for Stiff Person Syndrome: Successful Use of Total Intravenous Anaesthesia,” Anaesthesia, Vol. 61, No. 7, 2006, pp. 714-726.
[6]	E. Hattan, M. R. Angle and C. Chalk, “Unexpected Benefit of Propofol in Stiff-Person Syndrome,” Neurology, Vol. 70, No. 18, 2008, pp. 1641-1642. HUdoi:10.1212/01.wnl.0000284606.00074.f1U
[7]	S. W. Ying and P. A. Goldstein, “Propofol Suppresses Synaptic Responsiveness of Somatosensory Relay Neurons to Excitatory Input by Potentiating GABAA Receptor Chloride Channel,” Molecular Pain, Vol. 1, No. 2, 2005, p. 2.
[8]	A. Kitamura, R. Sato, W. Marszalec, J. Z. Yeh, R. Ogawa and T. Narahashi, “Halothane and Propofol Modulation of Gamma-Aminobutyric Acid—A Receptor-Channel Currents,” Anesthesia & Analgesia, Vol. 99, No. 2, 2004, pp. 409-415. HUdoi:10.1213/01.ANE.0000131969.46439.71U
[9]	J. Bouw, K. Leenderste, M. A. Tijssen and M. Dzoljic, “Stiff Person Syndrome and Anesthesia: Case Report,” Anesthesia & Analgesia, Vol. 97, No. 2, 2003, pp. 486487. HUdoi:10.1213/01.ANE.0000072701.97699.79U
[10]	J. O. Johnson and K. A. Miller, “Anesthetic Implications in Stiff-Person Syndrome,” Anesthesia & Analgesia, Vol. 80, 1995, pp. 612-613.
[11]	H. Shanthanna, “Stiff Man Syndrome and Anaesthetic Considerations: Successful Management Using Combined Spinal Epidural Anaesthesia,” Journal of Anaesthesiology Clinical Pharmacology, Vol. 26, No. 4, 2010, pp. 547549.