Opioid use may be associated with postoperative complications in myotonic dystrophy type 1 with high-grade muscular impairment

Abstract

Individuals with myotonic dystrophy type 1 (DM1) reportedly have a higher risk of postoperative complications than those without DM1; however, factors related to perioperative complications in DM1 patients remain unclear. We aimed to identify the risk factors that may be associated with postoperative complications in DM1 patients. We reviewed medical records of 256 patients with DM1 from 1998 to 2018, among whom 42 (16.4%) had previously undergone 51 surgeries under general and regional anaesthesia. Among the 42 patients, 11 (21.5%) had 13 postoperative complications including respiratory complications, sustained hypotension, wound infection and dehiscence, artery thrombosis and occlusion, and delayed recovery from anaesthesia. There were significant inter-group differences between the non-complicated and complicated groups considering the following parameters: high-grade (≥ 3) muscular impairment rating scale (MIRS), extubation time, postoperative opioid use, and hospital length of stay. Furthermore, univariate analysis revealed that an MIRS score ≥ 3 (odds ratio [OR] 9.346, confidence interval [CI] 1.761–49.595, p = 0.009) and postoperative opioid use (OR 8.000, CI 1.772–36.127, p = 0.007) were the only statistically significant factors. Therefore, clinicians should be cautious in administering opioids, particularly in patients with a high-grade MIRS score during the perioperative period.

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

“… 41 Opioid use was possibly associated with postoperative complications in a small retrospective study on the anesthetic management of DMI. 30 In this group of “other studies” the complication rates varied from 0% to 54%. Respiratory complications were frequently reported.…”

“…Other studies were on the anesthetic management of patients with myotonic dystrophy type I (DMI) 29 , 30 and II, 31 , 32 amyotrophic lateral sclerosis, 33 – 35 Duchenne muscular dystrophy, 36 glycogen storage disease, 37 inclusion body myositis, 38 Lambert–Eaton myasthenic syndrome, 39 mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes mitochondrial encephalomyopathy 40 and OPMD. 41 Opioid use was possibly associated with postoperative complications in a small retrospective study on the anesthetic management of DMI.…”

259th ENMC international workshop: Anaesthesia and neuromuscular disorders 11 December, 2020 and 28–29 May, 2021

“…Neuromuscular monitoring and reversal of residual neuromuscular blockade is recommended [10][11][12] , preferably with rocuronium and sugammadex [12 , 13] . Succinylcholine, long-acting opiates and cholinesterase inhibitors should be avoided [14] .…”

Hereditary gynecologic tumors and precision cancer medicine

“…131 In the surgical treatment of cancer, the risk of respiratory impairment and cardiac conduction system depression due to anesthesia and perioperative respiratory rehabilitation should also be considered. 132 Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is an autosomal dominant cancer syndrome characterized by cutaneous and uterine leiomyoma and renal carcinoma, diagnosed as a heterozygous GPV in fumarate hydratase (FH) deficiency based on genetic testing. Uterine leiomyomas are found in most natal female patients with HLRCC 133 and tend to be more numerous and larger at a younger age than in the general population.…”

“…Recently, an association between type 2 diabetes and cancer risk in patients with DM1 and the efficacy of metformin has been suggested 131 . In the surgical treatment of cancer, the risk of respiratory impairment and cardiac conduction system depression due to anesthesia and perioperative respiratory rehabilitation should also be considered 132 …”