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Side effects of anesthesia in DM2 as compared to DM1: a comparative retrospective study
L Kirzinger1, A Schmidt, C Kornblum
1Department of Neurology, Friedrich-Baur Institute, Ludwig Maximilians University Munich, Munich, Germany.
Background And Purpose:
Myotonic dystrophy type 2 (DM2) is an adult-onset progressive multisystem disease. There have been no reported risks for anesthesia in DM2.
Methods:
We assess the frequency, type, and severity of peri-operative complications under general and local anesthesia in genetically proven DM2. A retrospective multicenter study was conducted.
Results:
Out of 320 DM2 patients, 134 participated by completing questionnaires (41, 88%), which were delivered by mail, and their clinical records were reviewed (class III evidence). A total of 121 patients had 340 operations in general anesthesia at an average age of 40.5 years (range 18-82); 132 (38.8%) general anesthesia were performed prior to DM2 onset, 187 (55.9%) after disease onset. A total of 212 (62.4%) of the interventions were performed without known DM2 diagnosis. In 120 (35.3%) interventions, DM2 was already diagnosed. The locations of surgery were lower abdomen (47%), peripheral extremities (46.8%), upper abdomen (3.8%), thorax (1.8%), and brain (0.6%). The overall frequency of severe complications was 0.6% (2 of 340). One incident was a post-operative development of rhabdomyolysis, hyperthermia, muscle weakness and renal failure; the others, prolonged muscular weakness and renal failure. Minor complications related to a general anesthesia were reported by 27 participants (20.2%). In 116 patients (86.6%), 342 interventions were performed in regional anesthesia. Minor complications were reported by 20.2% participants such as nausea (6.7%), muscular weakness and pain (5.9%), prolonged anesthesia (5.2%), circulatory insufficiency (2.9%), and shortness of breath (2.9%).
Conclusion:
The overall lower risk seems to be predominantly related to the minor respiratory involvement in DM2, than in myotonic dystrophy type 1 (DM1).
Insights
Anesthesia in myotonic dystrophy type 2 (DM2) patients shows a low risk of severe peri-operative complications. This study found fewer respiratory issues compared to myotonic dystrophy type 1 (DM1), suggesting improved safety for DM2 patients undergoing surgery.
Area of Science:
- Neurology
- Anesthesiology
- Genetics
Background:
- Myotonic dystrophy type 2 (DM2) is a progressive, adult-onset multisystem disorder.
- Previous literature has not identified specific anesthesia risks for DM2 patients.
Purpose of the Study:
- To evaluate the frequency, type, and severity of peri-operative complications in patients with genetically confirmed DM2.
- To compare complication risks under general versus local anesthesia in DM2.
Main Methods:
- A retrospective, multicenter study involving 134 DM2 patients who completed questionnaires and had clinical records reviewed.
- Analysis of 340 operations under general anesthesia and 342 under regional anesthesia across various surgical sites.
Main Results:
- Severe complications occurred in 0.6% of general anesthesia cases (rhabdomyolysis, renal failure, prolonged muscle weakness).
- Minor complications were reported by 20.2% of patients under general anesthesia and 20.2% under regional anesthesia.
- Surgical sites included lower abdomen (47%) and peripheral extremities (46.8%).
Conclusions:
- DM2 patients exhibit a lower overall risk of peri-operative complications compared to DM1 patients.
- This reduced risk is likely attributed to the less severe respiratory involvement in DM2.
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