Anaesthetic management in patients with Duchenne muscular dystrophy undergoing orthopaedic surgery

Abstract

This retrospective survey confirms clinical experience that total intravenous anaesthesia can be used safely in Duchenne patients without major concern. Further prospective studies are necessary to establish evidence-based clinical guidelines for daily practice.

Duchenne muscular dystrophy: the management of scoliosis

“…The depolarizing muscle relaxant suxamethonium is absolutely contraindicated, due its association with rhabdomyolysis and potentially fatal hyperkalaemia. Malignant hyperthermia does not occur in DMD but a similar syndrome of anaesthetic induced rhabdomyolysis (AIR) is well recognised and is associated, albeit rarely, with the use of volatile anaesthetic agents, such as isoflurane (53). However, this is less common in older children with DMD, as there is less muscle regeneration.…”

“…However, this is less common in older children with DMD, as there is less muscle regeneration. Therefore although volatile anaesthetic agents are still used in these children, there is a move towards the use of total intravenous anaesthesia (TIVA), as there is significantly less risk with this method of anaesthesia (16,47,53).…”

Use of remifentanil and propofol without muscle relaxant with Duchenne muscular dystrophy - A case report -

“…According to Muenster et al [1], 4% of DMD patients experience difficult intubation, while the rate increases to 7.5% among elderly patients. Furthermore, Ramachandran et al [4] argued that the risk of supraglottic airway failure is increased 3.34-fold in patients with limited cervical spinal range of motion and 1.25-fold in patients with limited mouth opening compared with the normal group, although this was statistically insignificant.…”

“…During anesthesia, rhabdomyolysis, malignant hyperthermia, and cardiac arrest are known risks caused by an inhalation anesthetic or succinylcholine; therefore, the selection of inhalation anesthetics or muscle relaxants requires caution. According to a study by Muenster et al [1], 4% of DMD patients had difficult intubations and the frequency was especially high in older patients [2]. Thus, difficulty in securing the airway can be anticipated and sufficient muscle relaxation is required.…”

Duchenne Muscular Dystrophy: Management of Difficult Airway and Concurrent Bronchospasm

“…Bronchospasm encountered during the perioperative period and especially after induction and intubation may involve an immediate hypersensitivity reaction. To prevent reflex bronchoconstriction caused in patients with DMD compared with the general population [10]. It is generally agreed that depolarizing muscle relaxants should not be used in DMD patients, but there is no strong evidence to confirm that volatile anesthetics are absolutely contraindicated.…”