Management considerations for a patient with Isaacs syndrome versus cramp fasciculation syndrome on dantrolene: A case report

Isaacs syndrome (IS) is a rare condition that causes muscle stiffness, myokymia, and muscle twitching which may impact the surgical field, patient respiratory function, and patient comfort. Cramp fasciculation syndrome (CSF) presents with a less severe clinical picture but may impact patient lifestyle. We present a report of a successful total intravenous anesthetic using rocuronium and sugammadex for a patient with IS/CFS undergoing inguinal hernia repair. The consideration for TIVA was influenced by the patient's chronic use of dantrolene therapy. The patient did not receive preemptive administration of dantrolene, but intravenous dantrolene was immediately available if the patient had symptomatic muscle stiffness or myokymia.