Vecuronium and McArdle's disease

McArdle's disease does not seem to cause severe perioperative problems in routine anaesthetic care. However, measures for preventing muscle ischaemia and rhabdomyolysis should be kept in mind, as well as the potential for these patients to develop postoperative fatigue, myoglobinuria and renal failure. Although no clinical association with malignant hyperthermia has been established, many of these patients can have a positive in vitro contracture test, and simple prophylactic measures, as with malignant hyperthermia, may be recommended if otherwise not contraindicated.

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McArdle's disease and anaesthesia: Case reports. Review of potential problems and association with malignant hyperthermia

Bollig

Mohr

Ræder

2005

Acta Anaesthesiol Scand

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Anesthetic Management of Patients With Inborn Errors of Metabolism

Kloesel

Holzman

2017

Anesthesia &Amp; Analgesia

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Inborn errors of metabolism (IEM) are characterized by the body's inability to convert food into energy. The pathogenetic mechanism is based on defects in a variety of cellular enzymes. In addition to impairment of energy generation, accumulation of substrates may occur, which can deposit in tissue and lead to organ dysfunction. IEM can have profound implications for perioperative management, including difficult airway management, cardiac dysfunction, aspiration risk, seizures, and metabolic dysregulation. For the anesthesiologist, comprehensive knowledge is difficult to attain because of the heterogeneity of this group and the low prevalence of specific diseases. The first part of this article reviews intermediary metabolism, whereas the second part aims to highlight important aspects in perioperative management of patients with IEM. Instead of reviewing each single disorder within the vast group of IEM, we provide a conceptual framework that will facilitate the understanding of main problems encountered in each of the disease subgroups.

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Anesthetic Management of a Patient With McArdle Disease: A Case Report and Review of the Literature

Kotha,

Jones,

Girgenti

et al. 2023

Cureus

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McArdle disease (glycogen storage disorder type V) is a rare inherited condition resulting in impaired energy metabolism. Challenges in anesthetized patients with McArdle disease include hypoglycemia, rhabdomyolysis, myoglobinuria, acute renal failure, and postoperative fatigue. We review the literature and discuss a successful anesthetic that had no perioperative complications for a patient with McArdle disease undergoing robotic-assisted lung wedge resection. Preoperatively, we obtained a complete blood count, chemistry panel, and creatine kinase level. Intraoperatively, we proceeded with general endotracheal anesthesia and monitored point-of-care electrolytes, hemoglobin, and blood glucose. The patient had an uneventful postoperative recovery and was discharged home on postoperative Day 3. Patients with McArdle disease can undergo safe surgery with appropriate perioperative planning and a well-managed anesthetic. Efforts should focus on mitigating the risks of hypoglycemia, rhabdomyolysis, myoglobinuria, acute renal failure, and postoperative fatigue.

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Vecuronium and McArdle's disease

Cited by 3 publications

References 2 publications

McArdle's disease and anaesthesia: Case reports. Review of potential problems and association with malignant hyperthermia

McArdle's disease and anaesthesia: Case reports. Review of potential problems and association with malignant hyperthermia

Anesthetic Management of Patients With Inborn Errors of Metabolism

Anesthetic Management of a Patient With McArdle Disease: A Case Report and Review of the Literature

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