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- Title
Perioperative Management in Neuromuscular Diseases: A Narrative Review.
- Authors
Bhat, Aparna; Dean, Jason; Aboussouan, Loutfi S.
- Abstract
Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome.
- Subjects
NEUROMUSCULAR diseases; DISEASE management; MALIGNANT hyperthermia; NONINVASIVE ventilation; DRUG side effects; ARTIFICIAL respiration; HYPOVENTILATION; ASPIRATION pneumonia; PULMONARY function tests
- Publication
Journal of Clinical Medicine, 2024, Vol 13, Issue 10, p2963
- ISSN
2077-0383
- Publication type
Article
- DOI
10.3390/jcm13102963