A 43 year old female patient came with proximal muscle weakness, difficulty in breathing and headache. She was unsuccessfully treated with antihistaminics, antibiotics and steroid therapy. On examination she had erythematous lesion on the face with periorbital oedema, scaly lesions over the scalp, pruritis and Heliotropic rashes on the neck,upper limbs and upper chest region.

Neurologists confirmed the diagnosis of Dermatomyositis as Systemic corticotherapy of 500 mg methylprednisolone initiated showed a significant improvement in muscle weakness and skin lesions.

On physical examination a right breat lump was noted. A surgery opinion was obtained; FNAC was reported as paraneoplasticdermatomyositis associated T2N1MX Carcinoma of right breast. The patient was posted for Right modified radical mastectomy under General anesthesia. After obtaining high risk consent and post operative ventilation consent, IV line was secured and preinduction monitors like ECG, NIBP and SPO2 were connected.

Patient was preoxygenated and induced with midazolam 1 mg, fentanyl 100 mcg, xylocard(2%lignocaine) 20 mg and propofol in graded doses upto 300 mg was given. Airway was secured with 7.5mm endotracheal tube, confirmed by auscultation and ETCO2 monitoring. Neuromuscular monitoring was attached and muscle relaxant given based on requirement to a total of 100 mg Atracurium with maintenance of depth of anaesthesia with oxygen, nitrous oxide and Sevoflurane. On completion of procedure patient was extubated once fully awake and muscle power regained.

Sensitivity of patients with Dermatomyositis to neuromuscular blocking agents is kept in mind as anaesthetic morbidity in perioperative period can occur.