Anesthetic management of 877 pediatric patients undergoing muscle biopsy for neuromuscular disorders: a 20‐year review

Shapiro, Frederic; Athiraman, Umeshkumar; Clendenin, David; Hoagland, Monica; Sethna, Navil F.

doi:10.1111/pan.12909

Cited by 106 publications

(28 citation statements)

References 75 publications

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“…Given the complexity of perioperative management in patients with NMDs and the potential for poor outcomes in patients that are not managed judiciously, there exists a need for establishing multidisciplinary guidance for standardizing the care these patients receive. A large retrospective study of patients with NMDs undergoing muscle biopsies revealed no serious complications, and its authors concluded that “increased awareness of anesthesia-related concerns in an NMD patient directs management along specific safe pathways” [ 25 ]. While increased awareness is evident from multiple existing reviews of perioperative concerns for patients with NMDs [ 5 , 17 , 18 , 19 , 20 , 24 , 26 , 27 , 28 , 29 ], most have been directed toward anesthesia providers and very few define in precise and actionable ways the “specific safe pathways” that should be followed throughout the perioperative continuum of care.…”

Section: Multidisciplinary Considerations For Perioperative Care Fmentioning

confidence: 99%

Multidisciplinary Perioperative Care for Children with Neuromuscular Disorders

et al. 2018

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Children with neuromuscular diseases present unique challenges to providing safe and appropriate perioperative care. Given the spectrum of disease etiologies and manifestations, this is a population that often requires specialized multidisciplinary care from pediatricians, geneticists, neurologists, dieticians, and pulmonologists which must also be coordinated with surgeons and anesthesiologists when these patients present for surgery. Several of these diseases also have specific pharmacologic implications for anesthesia, most notably mitochondrial disease and muscular dystrophies, which put them at additional risk during the perioperative period particularly in patients presenting without a formal diagnosis. Techniques and strategies to fully evaluate and optimize these patients preoperatively, manage them safely intraoperatively, and return them to their baseline status postoperative are particularly important in this vulnerable group of patients. Utilizing a review of inherited neuromuscular conditions, generalized perioperative concerns, and specific complications related to anesthesia, this article provides an overview of pertinent considerations and recommends a framework for management of these patients.

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Section: Multidisciplinary Considerations For Perioperative Care Fmentioning

confidence: 99%

Multidisciplinary Perioperative Care for Children with Neuromuscular Disorders

et al. 2018

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“…Specific proteins within the dystrophin‐glycoprotein complex, responsible for muscle membrane stability , are abnormal in the dystrophies and certain of the myopathies. Children with these rare diseases appear to be at increased risk of developing AIR on exposure to halogenated agents yet the reaction is idiosyncratic, not happening in every patient, and not with every exposure, as demonstrated in two case series in which no such reactions were recorded despite the use, in certain cases, of suxamethonium and/or halogenated agents. It would appear that more than just the presence of a disorder and such an agent is required.…”

Section: Diagnosismentioning

confidence: 99%

Anesthesia‐induced rhabdomyolysis or malignant hyperthermia: is defining the crisis important?

Gray

2017

Pediatric Anesthesia

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Anesthesia-induced rhabdomyolysis and malignant hyperthermia occur in response to the same agents and present with similar clinical features. Distinguishing between these diagnoses can be challenging in a clinical crisis yet making the distinction is critical as prompt appropriate management may be life-saving, whereas delayed recognition and/or inappropriate management will almost certainly result in death. This focused review examines the differences between these conditions and focuses on the emergency management of anesthesia-induced rhabdomyolysis.

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“…8 Os pacientes suscetíveis à hipertermia maligna também devem evitar uso de bloqueadores de canal de cálcio. Não há relato de associação entre episódios de hipertermia maligna e uso de relaxantes musculares adespolarizantes [9][10][11] , porém devem ser evitados em todos os pacientes portadores de doenças neuromusculares, visto que a maioria desses pacientes apresenta mais sensibilidade a esses agentes, com instalação mais rápida do bloqueio e mais tempo de ação. 10 Se o uso for absolutamente necessário, devem-se utilizar 10 a 20% da dose recomendada e monitorar o grau de bloqueio neuromuscular.…”

Section: Poliomieliteunclassified

Anesthetic avaliation and management in special situations

Souza¹,

Ferreira²,

Faria³

et al. 2016

Revista Médica De Minas Gerais

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A segurança do ato anestésico ganha cada vez mais importância na Medicina atual e, nesse ínterim, a consulta pré-anestésica tem se revelado como premissa no que se refere à prevenção de complicações anestésico-cirúrgicas. Assim, este artigo objetiva discorrer sobre algumas das situações especiais com as quais o anestesiologista eventualmente se depara, além de discutir a importância da consulta pré-anestésica na detecção precoce dessas situações, para que sejam tomadas condutas acertadas que tornem o ato anestésico mais seguro e efetivo. Entre essas situações especiais, o artigo discute comorbidades de baixa prevalência, mas de difícil manejo como a hipertermia maligna e doenças neuromusculares relacionadas, obesidade mórbida e suas implicações anestésicas, além de condutas em pacientes portadores de dispositivos cardíacos implantáveis. A importância dessa discussão abrange o fato de que condutas inadequadas podem gerar desfechos insatisfatórios para o paciente no perioperatório e, nesse cenário, a consulta pré-anestésica aliada à abordagem médica multidisciplinar e seguimento de protocolos institucionais torna-se cada vez mais essencial na preparação adequada do paciente para o ato anestésico-cirúrgico.

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Anesthetic management of 877 pediatric patients undergoing muscle biopsy for neuromuscular disorders: a 20‐year review

Abstract: In this retrospective study, no patient exhibited signs or symptoms of hyperkalemia or MH probably because the incidence is very low and becomes even less likely due to the selection of the various anesthetic agents and strategies administered.

Cited by 106 publications

References 75 publications

Multidisciplinary Perioperative Care for Children with Neuromuscular Disorders

Multidisciplinary Perioperative Care for Children with Neuromuscular Disorders

Anesthesia‐induced rhabdomyolysis or malignant hyperthermia: is defining the crisis important?

Anesthetic avaliation and management in special situations

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