The Patient With Neuromuscular Skeletal Disease Or Movenents Disorder

Question 1

Multiple sclerosis
1) Use of succinylcholine
2) Risk of Malignant Hyperthermia
3) Systemic manifestations
4) Anesthesia/perioperative concerns

Answer 1

1) Use of succinylcholine
Use depende on the degree of motor impairment

2) Risk of Malignant Hyperthermia
No risk

3) Systemic manifestations
Destruction of the CNS by demyelination affecting motor, sensory and autonomic nervous system

4) Anesthesia/perioperative concerns
No specific anesthesia agent preferred
Use of epidural reported
The use of regional anesthesia is controversial
Exacerbations with surgery, stress, elevated temperature

Question 2

Amyotrophic Lateral Sclerosis
1) Use of succinylcholine
2) Risk of Malignant Hyperthermia
3) Systemic manifestations
4) Anesthesia/perioperative concerns

Answer 2

1) Use of succinylcholine
Contraindicated: hyperkalemia

2) Risk of Malignant Hyperthermia
No risk

3) Systemic manifestations
Muscle atrophy, respiratory failure

4) Anesthesia/perioperative concerns
- Total intravenous anesthesia recommended
- Inhaled agents can be used
- Limit nondepolarizing NMBDs
- Periferal and neuroaxial anesthesia reported
- Advanced directives recommended for severe disease

Question 3

Postpolio syndrome

1) Use of succinylcholine
2) Risk of Malignant Hyperthermia
3) Systemic manifestations
4) Anesthesia/perioperative concerns

Answer 3

1) Use of succinylcholine
Safe use

2) Risk of Malignant Hyperthermia
No risk

3) Systemic manifestations
Bulbar, respiratory, dysphagia, seleep apnea

4) Anesthesia/perioperative concerns
- Increased sensitive to nondepolarizing NMBDs depending on motor impairment
- Reports for safe use of spinal and epidural anesthesia
- Postoperative pulmmonary arrest

Question 4

Hemiplagia after cerebrovascular acident

1) Use of succinylcholine
2) Risk of Malignant Hyperthermia
3) Systemic manifestations
4) Anesthesia/perioperative concerns

Answer 4

1) Use of succinylcholine
Contraindicated: risk of hiperkalemia- 7 days to 6 months

2) Risk of Malignant Hyperthermia
No risk

3) Systemic manifestations
Upper motor neuron, flacid affected side, contractures over time

4) Anesthesia/perioperative concerns
- Decreased effect of nondepolarizing NMBDs on affected side
- Reports os safety with regional
- Limited mobility
- Risk of deep venous thrombosis
- Impaired respiratory function

Question 5

Spinal muscular atrophy

1) Use of succinylcholine
2) Risk of Malignant Hyperthermia
3) Systemic manifestations
4) Anesthesia/perioperative concerns

Answer 5

1) Use of succinylcholine
Contraindicated: hyperkalemia

2) Risk of Malignant Hyperthermia
No risk

3) Systemic manifestations
Autossomal-recessive motor neuron diseas, cause of infant mortality

4) Anesthesia/perioperative concerns
- Increased sensitive to nondepolarizing NMBDs
- Regional anesthesia reported as safe
- Respiratory failure