Anesthetic management of a hydrocephalus patient with inclusion body myositis

Inclusion body myositis (IBM) is an inflammatory muscle disease characterized by slowly progressive muscle weakness and wasting, especially affecting proximal leg and distal arm. We report a successful anesthetic management of a 68-year-old male patient with IBM undergoing ventriculoperitoneal shunt. Anesthesia was induced and maintained with total intravenous anesthesia using propofol, remifentanil, and ketamine. The trachea was uneventfully intubated without muscle relaxants. Ultrasound-guided subcostal transversus abdominis plane block and rectus sheath block were performed with 0.25% levobupivacaine 45 ml that could provide good surgical condition without muscle relaxants. Intravenous flurbiprofen 50 mg and morphine 2 mg were used for postoperative analgesia. The patient’s emergence from general anesthesia and the postoperative course was uneventful.