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Complications during anaesthesia in patients with Duchenne's muscular dystrophy (a retrospective study)
U T Larsen1, B Juhl, O Hein-Sörensen
1Department of Anesthesiology, University Hospital of Aarhus, Denmark.
Abstract:
The purpose of this retrospective study was to estimate the frequency and severity of anaesthetic complications in patients with Duchenne's muscular dystrophy (DMD). Forty-four boys with DMD were exposed to anaesthesia and surgery 84 times during a period of 22 years (1965-86). The procedures took place at 15 different hospitals. Retrospective examination of the case records showed: 19 cases with local analgesia without any complications, and 18 of 65 general anaesthetics with minor or more serious complications. In ten cases an increase in body temperature above 37.5 degrees C was seen, five had abdominal pain and dark-coloured urine after surgery, and three had a critical perioperative course with a resemblance to malignant hyperthermia. The complications were almost exclusively related to the use of succinylcholine. The use of succinylcholine was dispersed through all ages. Three out of the eight patients with severe complications occurred 1.5, 2.5 and 4 years before the neuromuscular disease was diagnosed. Thus an unusual course of anaesthesia in male children calls for further investigation. Although it has been stated before that succinylcholine is contraindicated in patients with Duchenne's muscular dystrophy, the drug continues to be used.
Insights
Anesthetic complications, particularly those resembling malignant hyperthermia, are frequent in Duchenne muscular dystrophy patients. Succinylcholine use is strongly linked to these severe adverse events, even before diagnosis.
Area of Science:
- Anesthesiology
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Duchenne muscular dystrophy (DMD) is a severe genetic disorder affecting muscle function.
- Anesthetic management in DMD patients requires careful consideration due to potential complications.
- Previous reports suggest risks associated with certain anesthetic agents in DMD.
Observation:
- This retrospective study analyzed 84 anesthetic procedures in 44 boys with DMD over 22 years.
- Complications were evaluated following local analgesia and general anesthesia.
- Case records from 15 different hospitals were reviewed.
Findings:
- 19 local analgesia cases had no complications.
- 18 of 65 general anesthetics resulted in minor or serious complications.
- Complications included hyperthermia, abdominal pain, dark urine, and critical events mimicking malignant hyperthermia, predominantly linked to succinylcholine use.
Implications:
- Succinylcholine use in DMD patients is associated with significant anesthetic risks, including hyperthermia and critical perioperative events.
- These complications can occur even before a DMD diagnosis, highlighting the need for vigilance in pediatric anesthesia.
- The continued use of succinylcholine in DMD patients, despite contraindications, warrants further investigation and stricter adherence to safety guidelines.