MDA, in collaboration with the American College of Chest Physicians, has issued a consensus statement on management of patients with Duchenne muscular dystrophy (DMD) undergoing anesthesia or sedation.
The complete statement is published in the December 2007 issue of the journal Chest. A technical abstract and list of authors is available on the journal’s website. (The full paper requires a journal subscription.)
Valerie Cwik, MDA's executive vice president of research and medical director, along with several MDA clinic directors, pulmonologists and respiratory therapists, participated in its development. They noted that longer survival because of better cardiac and respiratory care in DMD has made it more likely that patients will undergo surgical procedures and more important that guidelines for patient care during and after surgery be developed.
In summary, the physicians listed the following recommendations.
- Consider using intravenous, rather than gas, anesthetics.
- 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 anesthesia 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.
©2008, Muscular Dystrophy Association