• Yunjung Rho, Jinmann Chon, Myung Chul Yoo, Ga Yang Shim, Sung Joon Chung, and Yunsoo Soh.
• Department of Physical Medicine and Rehabilitation Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
• Medicine (Baltimore). 2023 Dec 1; 102 (48): e36378e36378.

RationaleMyotonic dystrophy type 1 (DM-1) is a progressive multisystem genetic disorder that causes myotonia and both distal limb and facial/neck muscle weakness by expanding the CTG repeats of the DMPK gene in chromosome 19q13.3. General anesthesia is indicated in DM-1 patients owing to their sensitivity to anesthetic drugs such as opioids, hypnotics, and neuromuscular blocking agents.Patient ConcernsA 48-year-old male patient underwent a laparoscopic cholecystectomy for gallstones under general anesthesia. He experienced sudden cardiac arrest and respiratory failure the day after surgery. After a thorough review of past medical history, we recognized that 15 years prior, he had been diagnosed with classic type DM-1, but the diagnosis was not self-reported before general anesthesia. Symptoms of severe dysphagia developed subsequently. In a videofluoroscopic swallowing study (VFSS), we observed abrupt aggravation of myotonic dysphagia after general anesthesia. VFSS revealed cricopharyngeal opening dysfunction, with a remaining large residue in the pyriform sinus, resulting in a severe cricopharyngeal achalasia pattern.DiagnosisAcute cricopharyngeal achalasia after general anesthesia.Intervention And OutcomeThe patient underwent a dysphagia rehabilitation program that included cricopharyngeal opening exercises and functional electrical stimulation. However, no significant improvement was observed in the cricopharyngeal achalasia in a 3-month follow-up VFSS.LessonsLow body temperature and anesthetic medications such as opioids and hypnotic agents can induce myotonia in the cricopharyngeal muscle.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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