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General anesthesia with reduced rocuronium and sugammadex reversal safely enabled cesarean section in a patient with inclusion body myositisA single case shows safe anesthesia for a pregnant patient with inclusion body myositis

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Key Takeaway
Consider this single-case report as preliminary evidence that specific anesthetic precautions may facilitate safe cesarean delivery in inclusion body myositis.

This is a case report detailing the anesthetic management for a cesarean section in a 43-year-old pregnant patient with inclusion body myositis. The intervention involved general anesthesia with aspiration precautions, prophylaxis against malignant hyperthermia, a reduced dose of rocuronium, and reversal with sugammadex. The primary outcome was an uneventful extubation within 30 minutes postoperatively. Secondary outcomes included a newborn Apgar score of 10/10 at 1 and 5 minutes after delivery and patient discharge on postoperative day 4, with no complications reported.

The authors note that the perioperative anesthetic management for inclusion body myositis is rarely described. The main limitations of this report are its single-case design and the rarity of such cases. The authors suggest that general anesthesia may be a safe and feasible option for cesarean delivery in IBM patients with precautionary preparations, but they caution against overstating general anesthesia safety in IBM patients based on this single case.

A 43-year-old woman faced a difficult situation. She was pregnant and had inclusion body myositis, a condition that weakens muscles. Doctors needed to perform a cesarean section safely. This is a rare scenario because managing anesthesia for this specific muscle disease is not well described in medical records.

The medical team took special precautions. They used a reduced dose of rocuronium, a muscle relaxant, and prepared for malignant hyperthermia, a rare reaction to certain anesthetics. They also used sugammadex to reverse the muscle relaxant quickly. The goal was to ensure the mother could breathe on her own again fast after surgery.

The outcome was positive. The patient was able to breathe without a tube within 30 minutes after the operation. Her baby received a perfect score of 10 out of 10 on Apgar tests at one and five minutes. There were no reported complications or adverse events for the mother or the newborn. The patient was discharged on postoperative day 4.

This single case report suggests that general anesthesia can be a safe option for cesarean delivery in patients with inclusion body myositis. However, this is based on one person. The team noted that such management is rarely described. More data is needed to confirm these results for other patients.

What this means for you:
One case shows safe anesthesia for cesarean delivery in a pregnant patient with inclusion body myositis.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
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.
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