title: Recommendations for anesthesia and perioperative management of patients with neuromuscular disorders.
abstract: Patients with neuromuscular disorders are at high risk of intraoperative and postoperative complications. General anesthesia in these patients may exacerbate respiratory and cardiovascular failure due to a marked sensitivity to several anesthetic drugs. Moreover, succinylcholine and halogenated agents can trigger life-threatening reactions, such as malignant hyperthermia, rhabdomyolysis and severe hyperkalemia. Therefore, regional anesthesia should be used whenever possible. If general anesthesia is unavoidable, special precautions must be taken. In particular, for patients at increased risk of respiratory complications (i.e., postoperative atelectasis, acute respiratory failure, nosocomial infections), noninvasive ventilation associated with aggressive airway clearance techniques can successfully treat upper airway obstruction, hypoventilation and airway secretion retention, avoiding prolonged intubation and tracheotomy. Anesthesia and perioperative management of patients with neuromuscular disorders are described in this article. To grade the strength of recommendations and the quality of evidence we adopted the GRADE approach. In case of low-quality evidence, these recommendations represent the collective opinion of the expert panel.
authors: Pediatric Anesthesiology and Intensive Care Unit, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy. fabrizio.racca@gmail.com
authors: F
authors: F
authors: Racca
authors: T
authors: T
authors: Mongini
authors: A
authors: A
authors: Wolfler
authors: A
authors: A
authors: Vianello
authors: R
authors: R
authors: Cutrera
authors: L
authors: L
authors: Del Sorbo
authors: E C
authors: EC
authors: Capello
authors: C
authors: C
authors: Gregoretti
authors: R
authors: R
authors: Massa
authors: D
authors: D
authors: De Luca
authors: G
authors: G
authors: Conti
authors: V
authors: V
authors: Tegazzin
authors: A
authors: A
authors: Toscano
authors: V M
authors: VM
authors: Ranieri
mesh_terms: D058109:Airway Management; D000758:Anesthesia / Q000592:standards*; D006334:Heart Function Tests; D006801:Humans; D007430:Intraoperative Care; D009460:Neurologic Examination; D009468:Neuromuscular Diseases / Q000628:therapy*; D005791:Patient Care; D019990:Perioperative Care / Q000592:standards*; D011182:Postoperative Care; D011300:Preoperative Care; D012129:Respiratory Function Tests