Neuromuscular diseases and anesthesia

Abstract

Neuromuscular diseases represent a heterogeneous group of diseases, which is characterized by the involvement of many organic systems in addition to the symptoms of the neuromuscular system. Common characteristics of all neuromuscular diseases of importance for anaesthesiologists are a wide range of different clinical manifestations, almost always the involvement of the cardiovascular, respiratory and gastrointestinal systems, the use of a large number of drugs and the high risk of occurrence of perioperative complications. Therefore elective surgery should only be performed when the disease is in remission. Preoperative evaluation and optimization of comorbidity is a key task that significantly improves the outcome and implies a multidisciplinary approach (neurologist, physiatrist, pulmologist, cardiologist, surgeon). The goal of the anesthetic approach is to avoid perioperative complications such as respiratory and cardiac insufficiency and aspiration of gastric contents. When using general endotracheal anesthesia, it should be kept in mind that increased sensitivity to most anesthetic drugs, it can exacerbate respiratory and cardiovascular failure, the more frequent the emergence of life-threatening conditions: myasthenic crisis, malignant hyperthermia, rhabdomyolysis, severe hyperkalemia. A common feature of most patients with neuromuscular disease is the unpredictable reaction to depolarising muscle relaxants and increased sensitivity to non-relaxing muscle relaxants. Therefore, the perioperative application of neuromuscular blockade monitoring is essential for the patient. Regional anesthesia presents anesthesia of choice in most patients with neuromuscular disease whenever this surgical procedure permits.

Keywords

• anesthesia
• neuromuscular diseases
• monitoring of neuromuscular blockade