Myotonic dystrophy (dystrophia myotonica; DM) is an uncommon progressive hereditary muscle disorder that can present with variable severity at birth, in early childhood, or most commonly as an adult. Patients with DM, especially type 1 (DM1), are extremely sensitive to the respiratory depressant effects of sedative-hypnotics, anxiolytics, and opioid agonists. This case report describes a 37-year-old male patient with previously undiagnosed DM1 who received dental care under minimal sedation using intravenous midazolam. During the case, the patient experienced 2 brief episodes of hypoxemia, the second of which required emergency intubation after propofol and succinylcholine and resulted in extended hospital admission. A lipid emulsion (Liposyn II 20%) infusion was given approximately 2 hours after the last local anesthetic injection due to slight ST elevation and suspicion of local anesthetic toxicity (LAST). Months after treatment, the patient suffered a fall resulting in a fatal traumatic brain injury. Complications noted in this case report were primarily attributed to the unknown diagnosis of DM1, although additional precipitating factors were likely present. This report also provides a basic review of the literature and clinical guidelines for managing myotonic dystrophy patients for dental care with local anesthesia, sedation, or general anesthesia.
Complications After Dental Sedation: A Myotonic Mystery Case Report
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Milad Karamlou, Iman Asaria, Jaime Barron, Petra Boutros, Vincent Fisher, Rachel Grandinetti, Julian Johnson, Emily Richard, David Susko, Cristobal Urrutia, Bryce Woolsey, Ronald Baumann, James Cottle, Richard Sweaney, Mark Wenzel, John Nusstein, David Hall; Complications After Dental Sedation: A Myotonic Mystery Case Report. Anesth Prog 1 December 2022; 69 (4): 26–31. doi: https://doi.org/10.2344/anpr-69-02-09
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