A systematic review published recently in Frontiers in Medicine explored the risks and benefits of several anesthetic techniques in patients with Duchenne muscular dystrophy (DMD).
While individuals with DMD have an elevated risk of anesthesia-related complications, recent years have seen advancements in pre- and post-operative care for this patient population. However, no previous studies have explored whether these developments have improved outcomes.
The authors analyzed 40 studies in which patients with DMD received sedation or anesthesia prior to a medical procedure. Of these studies, 26 used general anesthesia, six used regional anesthesia, four used a combination of general and regional anesthesia, and four used procedural sedation, such as such as IV sedation or oral sedatives.
The study found that neuromuscular blocking agents (drugs used to temporarily paralyze muscles during surgery) took longer to take effect and resulted in a longer recovery time in patients with DMD compared to controls.
Read more about DMD treatment and care
Additionally, the need for anesthesia reversal was common among the studies analyzed, particularly in cases where too much anesthetic was administered. Sugammadex, neostigmine and atropine were typically prescribed to quickly reverse the effects of muscle relaxants that were administered during surgery.
Succinylcholine, a muscle relaxant, can cause dangerous complications in patients with DMD and should be avoided whenever possible, the authors emphasized. Cardiac arrest has been reported in many patients receiving the drug during surgery.
To avoid complications of general anesthesia and central neuraxial blockade, the authors recommended that peripheral nerve blocks or procedural sedation be used when appropriate. When general anesthesia is necessary, total intravenous anesthesia should be employed via propofol or short-acting opioids. Dantrolene may also be used to reverse hyperpyrexia, a complication of general and inhaled anesthesia that is defined as a fever over 106.7°F.
“Patients with DMD should receive a detailed preoperative assessment, thoughtful disease-specific intraoperative management and aggressive postoperative monitoring if they are to avoid anesthesia- and surgery-related morbidity and mortality,” the study concluded.
Sign up here to get the latest news, perspectives and information about DMD sent directly to your inbox. Registration is free and only takes a minute.
