Anesthetic Management of a Patient with Advanced Anti-Myelin-Associated Glycoprotein Antibody Neuropathy in the Absence of Measurable Quantitative Neuromuscular Responses: A Case Report

Description

Jun Yamaguchi, Joho Tokumine, Kiyoshi Moriyama, and Harumasa Nakazawa report anesthesia care for a 79-year-old man with a rare nerve disease during major bladder surgery, in a 2026 case report. His condition, driven by antibodies against a myelin protein, had weakened his legs until he used a wheelchair, with wasted hand muscles and no tendon reflexes. He faced robot-assisted bladder removal under combined general and spinal-block anesthesia.

Standard monitors for muscle-relaxing drugs were tried at the wrist nerve with two methods and at a brow muscle before any relaxant was given. Visible twitches followed nerve stimulation, yet neither method produced a readable signal at any site. With no reliable way to track drug depth or recovery, the team had to plan relaxant use blind. The authors note no guidelines exist for this disease and urge careful case planning when monitoring fails.

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Source: https://europepmc.org/article/MED/PMC13511504