The American College of Chest Physicians issued a consensus statement (published in Chest, 2007) on the management of patients with DMD undergoing anaesthesia or sedation.
Thanks to better cardiac and respiratory care, patients with Duchenne muscular dystrophy (DMD) are living longer than in the past. Increased lifespan means it is more likely that DMD patients will undergo surgical procedures. Therefore, it is important to be aware of the risks and guidelines for patient care during and after surgery.
Summary of the recommendations:
- Consider using intravenous, rather than gas, anaesthetics.
- Do not use depolarizing muscle relaxants, such as succinylcholine; fatal reactions can occur.
- Have an intensive care unit available for postoperative care.
- Provide respiratory support during anaesthesia or sedation, using any of a variety of techniques.
- Monitor blood oxygen saturation using pulse oximeter throughout the procedure.
- When possible, monitor blood or lung carbon dioxide levels.
- Consider moving the patient from intubation (tube in the trachea) during surgery to noninvasive positive pressure ventilation right after surgery.
- Use extreme caution when administering supplemental oxygen.
- Use manually assisted cough and insufflation-exsufflation assisted cough postoperatively to clear secretions.
- Obtain a cardiology consultation, and closely monitor cardiac and fluid status postoperatively.
- Initiate bowel regimens to avoid and treat constipation.
- Consider gastric (stomach) decompression with a nasogastric tube.
- Start intravenous feeding or enteral (through the stomach and intestines) tube feeding if oral intake is delayed for more than 24 to 48 hours postoperatively.
Courtesy Muscular Dystrophy Association Inc.