Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Abstract

Purpose Patients with neuromuscular disorders (NMDs) are at increased risk of perioperative complications. The objective of this scoping review was to examine emerging evidence from published studies, case reports, and review articles on anesthetic management of patients with NMDs, following the methodological frame for scoping reviews. Sources We searched PubMed and EMBASE for articles published between 1 January 2000 and 14 July 2021. Principal findings Three prospective and 21 retrospective studies on altered pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBA) in NMD patients were included. Furthermore, 168 case reports/series reporting 212 anesthetics in 197 patients were included. These studies showed that preanesthetic neuromuscular monitoring can be used for precise NMBA dosing in myasthenia gravis patients. Sugammadex was associated with fewer postoperative myasthenic crises. Perioperative complications were not associated with specific anesthetic agents. Case reports/series showed that in 32% (67/212) of anesthetics, at least one complication was reported. Unexpected intensive care unit admission was a frequently reported complication. Patients with a complicated disease course may have had a higher use of succinylcholine (unadjusted relative risk, 0.13; 95% confidence interval [CI], 0.20 to 0.86) and volatile anesthetics (adjusted odds ratio [OR], 0.38; 95% CI, 0.20 to 0.73; P = 0.004). Conclusion Evidence on the anesthetic management and perioperative complications of patients with NMDs is mainly based on small retrospective studies and case reports. Further clinical trials or large retrospective studies are required to investigate the choice of safe anesthetic agents. Main areas of interest are the potential benefits of neuromuscular monitoring and sugammadex and the risks possibly associated with volatile anesthetics and succinylcholine. Supplementary Information The online version of this article contains supplementary material available 10.1007/s12630-022-02230-3.

European Neuromuscular Centre consensus statement on anaesthesia in patients with neuromuscular disorders

“…In preparation for the ENMC workshop, the organizers conducted a literature search covering the period 1 January 2000 to 14 July 2021 in PubMed and Embase using the methodological framework for scoping reviews [ 8 ]. The main findings of this literature search were disseminated to the participants and presented during the first part of the workshop.…”

“…Because of the low prevalence of most NMDs, there is a lack of prospective clinical studies with a high level of evidence on the anaesthetic management of patients with NMDs, resulting in several urgent open questions [ 8 ]. Observational multicentre studies can be of great value to study the prevalence of perioperative complications in patients with NMDs and the association with certain anaesthetic agents.…”

Comparison between Sugammadex and Neostigmine after Video-Assisted Thoracoscopic Surgery–Thymectomy in Patients with Myasthenia Gravis: A Single-Center Retrospective Exploratory Analysis

“…Double-lumen endobronchial tubes are the most common method of achieving lung isolation; however, intubation using double-lumen tubes for one-lung ventilation can be difficult compared to the use of single-lumen tubes due to the length, width, and less compliant characteristics of double-lumen tubes [ 2 ]. Thus, an adequate neuromuscular blockade is necessary for VATS–thymectomy, even for patients with MG [ 1 , 3 ]. However, general anesthesia in patients with MG carries an increased risk of complications due to sensitivity to neuromuscular blocking agents (NMBAs) [ 4 ], and their use can present a vexing dilemma for anesthesiologists.…”