ANESTHETIC MANAGEMENT FOR PATIENTS WITH MYOPATHIES

Abstract

Myopathies are diseases of skeletal muscle (myopathic) which are not caused by nerve disorders (not neurogenic) .These diseases cause the skeletal or voluntary muscles to become weak or wasted . There are many different types of myopathies, some of which are inherited (commonly muscular dystrophies), some inflammatory, and some caused by endocrine problems. Myopathies are rare and not usually fetal. Typically, effects are mild,largely causing muscle weakness and movement problems, and many are transitory. Only rarely will patients become dependent on a wheelchair. However, muscular dystrophy (which is technically a form of myopathies) is far more severe. Some types of this disease are fetal in early adulthood. Muscular dystrophies are a group of genetic disorders in which strength and muscle bulk gradually decline. Duchenne's muscular dystrophy is the most common and most severe form. Other major variants include Becker's type, facioscapulohumeral, and limb-girdle dystrophies. It is important for anesthesia, that these disorders show various symptoms and have a high risk during general anesthesia. Especially administration of succinylcholine and volatile anesthetics may cause problems. Also opioids, non-depolarizing muscle relaxants, and intravenous anesthetics can interfere with this kind of disorders. English Summary 97 Pre-operative examination should include the detection of associated cardiac and respiratory dysfunction, a neurological examination for scoring myopathic symptoms, electrocardiogram, chest X-ray, pulmonary function tests,arterial blood gas analysis, determination of serum Na+, K+, Cl-, Ca+2, Mg+2 and CK are important for anesthesia of these patients. For pre-medication, substances leading to respiratory depression or decreased muscle tone are often not used in severely affected individuals. Regional or local anesthetic techniques can be employed in patients with cardiac and/or respiratory dysfunction. The use of neuromuscular blocking agents (even in healthy individuals) must be done under complete monitoring to prevent residual muscle paralysis after recovery from anesthesia. In patients with myopathies , the anesthesiologist must do a preoperative select of the appropriate anesthetic technique and muscle relaxant (if needed). Patients suffering from muscular dystrophies have an elevated anesthetic risk to develop malignant hyperthermia or rhabdomyolysis. In addition serious cardio-pulmonary complications are imminent during anesthesia. In cases of MH, The family history of death under general anesthesia, musculoskeletal abnormalities will be helpful to detect MH susceptibles, and giving a chance to the anesthesiologist to follow the MH protocol of preoperative preparation and intraoperative management, English Summary