General anesthesia with reduced rocuronium and sugammadex reversal safely enabled cesarean section in a patient with inclusion body myositis

Inclusion body myositis (IBM) is a rare inflammatory myopathy characterized by progressive limb muscle weakness, dysphagia, and respiratory impairment. In this report, we review the case of a pregnant patient with IBM who underwent cesarean section safely under general anesthesia. Perioperative anesthetic management for these patients has been rarely described. We describe a 43-year-old parturient (G2P1) who was diagnosed with IBM 7 years prior to this pregnancy, with confirmed involvement of the flexor digitorum profundus and quadriceps muscles. She had mild dysphagia but no respiratory muscle involvement. Due to gestational diabetes mellitus and fetal macrosomia, she required a cesarean section. General anesthesia was administered with aspiration precautions and prophylaxis against malignant hyperthermia (MH). General anesthesia, combined with a reduced dose of rocuronium and reversal with sugammadex, facilitated uneventful extubation within 30 min postoperatively. The newborn was assigned a 10/10 Apgar score at 1 and 5 min after delivery, and the patient was discharged on postoperative day 4 without complications. This case demonstrates that, with precautionary preparations targeting potential complications—including aspiration risk, MH, exaggerated sensitivity to neuromuscular blocking agents (NMBAs), and postoperative pulmonary complications—general anesthesia may be a safe and feasible option for cesarean delivery in IBM patients.