How should we monitor pediatric patients with Duchenne muscular dystrophy? -A case report-

Area of Science:

• Anesthesiology
• Pediatric Neurology
• Clinical Case Reports

Background:

• Duchenne muscular dystrophy (DMD) presents progressive muscle weakness, necessitating specialized anesthetic care.
• Inhalational anesthetics and succinylcholine pose fatal risks in DMD patients, favoring intravenous anesthetic use.
• Monitoring standards for pediatric DMD anesthesia are not well-defined.

Purpose of the Study:

• To report the anesthetic management of a pediatric patient with suspected Duchenne muscular dystrophy undergoing muscle biopsy.
• To evaluate the safety and efficacy of a specific intravenous anesthetic protocol and neuromuscular blockade monitoring.

Main Methods:

• A 6-year-old boy with suspected DMD received midazolam, fentanyl, propofol, and a low dose of rocuronium for general anesthesia.
• Neuromuscular blockade was monitored using acceleromyography (train-of-four, TOF) and bispectral index (BIS).
• Reversal of neuromuscular block was achieved with pyridostigmine and glycopyrrolate, confirmed quantitatively and clinically before extubation.

Main Results:

• The anesthetic management was successfully completed without any intraoperative or postoperative complications.
• Quantitative monitoring confirmed adequate recovery of neuromuscular function (TOF ratio > 90%) prior to extubation.
• The chosen anesthetic regimen and monitoring approach proved effective and safe for this pediatric DMD case.

Conclusions:

• Intravenous anesthetics and careful neuromuscular blockade monitoring are crucial for safe anesthesia in pediatric Duchenne muscular dystrophy.
• Quantitative TOF monitoring and appropriate reversal agents facilitate successful extubation and recovery.
• This case demonstrates a viable anesthetic strategy for pediatric patients with suspected DMD.