Anesthetic consideration for neuromuscular diseases

Katz, Jeffery A.; Murphy, Glenn S.

doi:10.1097/aco.0000000000000466

Cited by 36 publications

(42 citation statements)

References 79 publications

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“…Several cases of hyperthermia possibly related to the use of anesthetics have been reported in FSS, and an inherent risk of MH cannot be safely confirmed or ruled out to date [ 9 , 10 ]. Therefore, some authors recommend avoiding the use of potential triggers as best practice in FSS altogether.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Considerations for an Adult Patient with Freeman-Sheldon Syndrome Undergoing Open Heart Surgery

Viehmeyer¹,

Gabriel²,

Bauer³

et al. 2018

Case Reports in Anesthesiology

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Freeman-Sheldon syndrome (FSS) or “whistling face” syndrome is a rare congenital disorder complicated by characteristic facial deformities and muscular contractures. We report on a 64-year-old male patient presenting for surgical replacement of his aortic valve and review the available literature on anesthetic considerations and perioperative management principles. FSS frequently poses a significant challenge to airway management and gaining vascular access. Moreover, these patients are reportedly at risk for developing malignant hyperthermia (MH) or neuroleptic malignant syndrome.

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Section: Discussionmentioning

confidence: 99%

Anesthetic Considerations for an Adult Patient with Freeman-Sheldon Syndrome Undergoing Open Heart Surgery

Viehmeyer¹,

Gabriel²,

Bauer³

et al. 2018

Case Reports in Anesthesiology

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“…Besides, patients with NMD should be cautious about the side effects of neuromuscular blockers and anesthetics. Succinylcholine, a depolarizing muscle relaxant, should be avoided in patients with muscular dystrophies, motor neuron diseases, and intrinsic muscle disease because of the risk of malignant hyperthermia, fatal hyperkalemia, and rhabdomyolysis (35)(36)(37). Nondepolarizing muscle relaxants should be reduced dosage and titrated carefully in some categories of NMD, including myotonic muscular dystrophy, MG, congenital myasthenic syndrome, SMA, polymyositis, and dysimmune neuropathies (36,37).…”

Section: Management Of Nmd Patients With Covid-19 Infection Respiratomentioning

confidence: 99%

Care for Patients With Neuromuscular Disorders in the COVID-19 Pandemic Era

Tseng

Chen

2021

Front. Neurol.

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The coronavirus disease 2019 (COVID-19) pandemic has prompted a rapid and unprecedented reorganization of medical institutions, affecting clinical care for patients with chronic neurological diseases. Although there is no evidence that patients with neuromuscular disorders (NMD) confer a higher infection risk of COVID-19, NMD and its associated therapies may affect the patient's ability to cope with infection or its systemic effects. Moreover, there is a concern that patients with chronic NMD may be at increased risk of manifesting severe symptoms of COVID-19. In particular, as respiratory compromises account for the major cause of mortality and morbidity in NMD patients, newly emerging data also show that the risk of exacerbation caused by COVID-19 accumulates in this particular patient group. For example, patients with motor neuron disease and dystrophinopathies often have ventilatory muscle weakness or cardiomyopathy, which may increase the risk of severe COVID-19 infection. Thus, the COVID-19 pandemic may severely affect NMD patients. Several neurological associations and neuromuscular networks have recently guided the impact of COVID-19 on patients with NMD, especially in managing cardiopulmonary involvements. It is recommended that patients with moderate- to high-risk NMD be sophisticatedly monitored to reduce the risk of rapid decline in cardiopulmonary function or potential deterioration of the underlying NMD. However, limited neuromuscular-specific recommendations for NMD patients who contract COVID-19 and outcome data are lacking. There is an urgent need to properly modify the respiratory care method for NMD patients, especially during the COVID-19 pandemic. Conclusively, COVID-19 is a rapidly evolving field, and the practical guidelines for the management of NMD patients are frequently revised. There must be a close collaboration in a multidisciplinary care team that should support their hospital to define a standardized care method for NMD patients during the COVID pandemic. This article reviews evidence-based practical guidelines regarding care delivery, modification, and education, highlighting the need for team-based and interspecialty collaboration.

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“…Some patients will be referred as incident cases of hypercapnic respiratory failure, or respiratory muscle dysfunction of unknown origin for investigation. Others may be referred as part of pregnancy planning [14] or pre-operative assessment [15], if they are considered to be at risk of respiratory muscle weakness during the perioperative period. Any patient referred in to the adult NMD clinic will benefit from a core set of baseline investigations (table 2) [16].…”

Section: The Multidisciplinary Respiratory Clinicmentioning

confidence: 99%

The adult multidisciplinary respiratory neuromuscular clinic

Shah

Murphy

Kaltsakas

2020

Breathe

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Many neuromuscular disorders (NMD) are complicated by respiratory failure. These patients are best managed in a multidisciplinary outpatient clinic to provide timely access to the various disciplines they require. The key mainstay of treatment of respiratory failure in patients with NMD is noninvasive ventilation, supported by secretion clearance, speech and language therapy, optimisation of nutrition and the maintenance of mobility. Patients with specific conditions may also require cardiology, neurology, orthopaedics, urology and psychological services. The respiratory NMD multidisciplinary team should also provide access to palliative care, and caregiver health and wellbeing should also be reviewed at clinical reviews. The future of care for the respiratory NMD patient will increasingly involve home services and telehealth and the clinic should be equipped and resourced to deliver these. Although not all health systems will be able to provide all elements of the multidisciplinary team discussed here, this review provides the “ideal” recipe for the adult multidisciplinary team and the evidence base underpinning this from which a clinic can be developed.Educational aimsTo provide an overview of the care of an adult neuromuscular disorder patient presenting to the multidisciplinary respiratory clinic.To provide the evidence base for establishing the different elements of the multidisciplinary respiratory clinic.

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Anesthetic consideration for neuromuscular diseases

Abstract: Careful assessment and management of patients with underlying neuromuscular diseases is required to reduce postoperative complications. This article reviews the anesthetic implications of patients undergoing surgery with neuromuscular disorder.

Cited by 36 publications

References 79 publications

Anesthetic Considerations for an Adult Patient with Freeman-Sheldon Syndrome Undergoing Open Heart Surgery

Anesthetic Considerations for an Adult Patient with Freeman-Sheldon Syndrome Undergoing Open Heart Surgery

Care for Patients With Neuromuscular Disorders in the COVID-19 Pandemic Era

The adult multidisciplinary respiratory neuromuscular clinic

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