Anesthetic Management for Patient with Poems Syndrome

We provided anesthesia for a 65-year-old female undergoing right lumpectomy. Preoperative examination revealed significant ascites and heart failure. Additional examination confirmed increased level of M protein, plasma vascular and endothelial growth factor (VEGF), as well as polyneuropathy. The patient was diagnosed with POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin abnormalities) syndrome, in which prolonged duration of action of neuromuscular blocking agents has been reported. Anesthesia was maintained with sevoflurane and remifentanil. We monitored the effects of rocuronium bromide using TOF-WatchTM. In this case, we did not find any prolonged effect of neuromuscular blocking agents and we successfully performed perioperative anesthetic management.