Perioperative Risks in Neuromuscular Diseases: an Update

Patients with neuromuscular diseases are at a high risk of peri-operative complications. Recent advances in the management of these disorders have increased the survival rates and the need for surgical procedures related or non-related to the primary disorder. Cardiac and respiratory failure are by far the commonest complications in addition to rhabdomyolysis, malignant hyperthermia, myotonic contractures and peri-operative drug induced complications. Meticulous preoperative assessment, optimization and a high index of suspicion for complications reduce the risks. Regional anesthesia is generally safer. If general anesthesia is required special precautions should be taken. These may vary form disease to disease and thus a multi-disciplinary approach involving the parent surgical team, neurology team, medical team, intensivist and anesthetist is of paramount importance. In this brief update the perioperative assessment and management of the common complications have been discussed along with a brief insight into the anesthetic drugs that may potentiate complications. A very brief description of the common neuromuscular disorders and respective anesthetic considerations has also been mentioned.