title: Anesthesia for Duchenne muscular dystrophy patients: case reports.
abstract: OBJECTIVE
  Reporting two cases of anesthesia in Duchenne Muscular Dystrophy (DMD) patients, which is an uncommon, progressive and disabling disease, and discussing anesthetic approaches, impairment of pulmonary and cardiac functions, the possibility of malignant hyperthermia, increased sensitivity to neuromuscular blockers and increased postoperative morbidity are some challenges faced by anesthesiologists.
  
  
  METHODS
  First case was a pediatric patient with DMD and rhabdomyosarcoma, scheduled for tumor excision and cervical emptying. During preanesthetic evaluation, history, clinical and additional exams, no changes were detected except for the cervical tumor. We decided for total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. Surgery lasted 180 minutes without intercurrences. The second case was a male patient, 24 years old, with DMD and cholelithiasis with surgical indication who, during preoperative evaluation, has revealed severe restrictive pneumopathy with decreased capacity and respiratory reserves and the need for nasal BIPAP at night. For this patient we decided for tracheal intubation with minimum sedation and topic anesthesia, followed by total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. At the end, patient was extubated still in to operating room and nasal BIPAP was immediately placed, being patient referred to the ICU. Patient was discharged from ICU in the 2nd PO day and from hospital in the 3rd PO day.
  
  
  CONCLUSIONS
  Total intravenous anesthesia with propofol and remifentanil administered by continuous infusion without neuromuscular blockers is a safe and effective option for DMD patients.
authors.affiliation: Hospital Monte Sinai, Hospital Agregadodo CET/SBA do Hospital Universitário da Universidade Federal de Juizde Fora (HU-UFJF), Juiz de Fora, MG. drigomg@terra.com.br
authors.forename: Rodrigo Machado
authors.initials: RM
authors.lastname: Saldanha
authors.forename: Juliano Rodrigues
authors.initials: JR
authors.lastname: Gasparini
authors.forename: Letícia Sales
authors.initials: LS
authors.lastname: Silva
authors.forename: Roberto Rigueti
authors.initials: RR
authors.lastname: de Carli
authors.forename: Victor Ugo Dorigo
authors.initials: VU
authors.lastname: de Castilhos
authors.forename: Mariana Moraes Pereira
authors.initials: MM
authors.lastname: das Neves
authors.forename: Fernando Paiva
authors.initials: FP
authors.lastname: Araújo
authors.forename: Paulo César de Abreu
authors.initials: PC
authors.lastname: Sales
authors.forename: José Francisco Nunes Pereira
authors.initials: JF
authors.lastname: das Neves