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Minerva Anestesiologica 2013 April;79(4):419-33

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders

Racca F. ¹, Mongini T. ², Wolfler A. ³, Vianello A. ⁴, Cutrera R. ⁵, Del Sorbo L. ⁶, Capello E. C. ⁶, Gregoretti C. ⁷, Massa R. ⁸, De Luca D. ⁹, Conti G. ⁹, Tegazzin V. ¹⁰, Toscano A. ¹¹, Ranieri V. M. ⁶ ✉

¹ Pediatric Anesthesiology and Intensive Care Unit, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy; ² Department of Neurosciences, University of Turin, S. Giovanni Battista-Molinette Hospital, Turin, Italy; ³ Department of Anesthesiology and Intensive Care, Vittore Buzzi Children’s Hospital, Milan, Italy; ⁴ Respiratory Intensive Care Unit, Department of Cardio-Thoracic Surgery, University Hospital of Padua, Padua, Italy; ⁵ Respiratory Unit, Bambino Gesù Children Research Hospital, Rome, Italy; ⁶ Department of Anesthesiology and Intensive Care, University of Turin, S. Giovanni Battista-Molinette Hospital, Turin, Italy; ⁷ Department of Anesthesiology and Intensive Care, Azienda Ospedaliera CTO-CRF-Maria Adelaide, Turin, Italy; ⁸ Department of Neurosciences, University of Rome “Tor Vergata”, Rome and IRCCS Fondazione S. Lucia, Rome, Italy; ⁹ Pediatric Intensive Care Unit, Department of Anesthesiology and Intensive Care, Catholic University of the Sacred Heart, University Hospital ‘‘A. Gemelli’’, Rome, Italy; ¹⁰ MH Laboratory, S. Antonio University Hospital, Padua, Italy; ¹¹ UOC of Neurology and Neuromuscular Disorders, Regional Reference Center for Neuromuscular diseases, AOU Policlinico, “G. Martino”, University of Messina, Messina, Italy

Patients with neuromuscular disorders are at high risk of intraoperative and postoperative complications. General anesthesia in these patients may exacerbate respiratory and cardiovascular failure due to a marked sensitivity to several anesthetic drugs. Moreover, succinylcholine and halogenated agents can trigger life-threatening reactions, such as malignant hyperthermia, rhabdomyolysis and severe hyperkalemia. Therefore, regional anesthesia should be used whenever possible. If general anesthesia is unavoidable, special precautions must be taken. In particular, for patients at increased risk of respiratory complications (i.e., postoperative atelectasis, acute respiratory failure, nosocomial infections), noninvasive ventilation associated with aggressive airway clearance techniques can successfully treat upper airway obstruction, hypoventilation and airway secretion retention, avoiding prolonged intubation and tracheotomy. Anesthesia and perioperative management of patients with neuromuscular disorders are described in this article. To grade the strength of recommendations and the quality of evidence we adopted the GRADE approach. In case of low-quality evidence, these recommendations represent the collective opinion of the expert panel.