making muscle wasting history

There will be a variety of situations, both related to DMD (e.g. muscle biopsy, joint contracture surgery, spinal surgery, or gastrostomy) and unrelated (e.g. acute surgical events), where general anaesthesia may be needed. There are a number of condition-specific issues that need to be taken into account for the planning of safe surgery.

• Surgery should be done in a hospital where personnel involved in the operation and after care are familiar with DMD and willing to work together to be sure everything goes smoothly. In addition, consideration needs to be given to “stress steroid” coverage during surgery, for people treated with steroids at home. Anaesthetic agents and other considerations for safe operative care
• There are always risks with anaesthetics and there are special considerations in DMD to allow anaesthetics to be given safely including using total intravenous anaesthetics and avoiding specific drugs.
• Minimising loss of blood is important especially in major surgery such as spinal fusion. In this situation, the surgeon and anaesthetist may decide to use specific techniques to help with this.

IMPORTANT FACTS TO REMEMBER:

• There are always risks with anaesthesia; however, special considerations in DMD can allow anaesthesia to be given more safely, such as the use of a total intravenous anaesthesia technique and absolute avoidance of the drug succinylcholine.
• Proper assessments of the heart and lungs are important when planning for surgery.
• Make sure that all doctors are properly informed about DMD and all interventions (medicines) your son is getting.

Cardiac considerations

• An echocardiogram and electrocardiogram should be performed prior to general anaesthesia. They should also be performed before undergoing conscious sedation or regional anaesthesia if the last investigation was more than one year previously, or if there had been an abnormal echocardiogram in the preceding 7-12 months.
• For local anaesthesia, an echocardiogram should be performed if there had been an abnormal result obtained previously.

Respiratory considerations

• Even if someone with DMD already has problems with the breathing muscles, certain measures can make surgery safer, though there will still be an increased risk. A pre-operative assessment of breathing function in a centre familiar with DMD is very important. Pre-operative training in the use of non-invasive ventilation and assisted cough, and specialised interventions may be needed.
• Physiotherapists should always be involved if someone with DMD is having surgery.
• Planning and proactive assessments and management of risk is the key to safe surgery in DMD.