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Perioperative Medicine in Pediatric Anesthesia pp 159–174Cite as

Perioperative Care of Children with Neuromuscular Disease

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Abstract

Children 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 adopted whenever possible, even for children with preexisting peripheral nervous system disorders. If general anesthesia is unavoidable, special precautions must be taken, in particular for children at increased risk of respiratory complications (i.e., postoperative atelectasis, acute respiratory failure, nosocomial infections). All children with NMDs with limited respiratory reserve should be trained to use noninvasive ventilation and manual or mechanically assisted cough techniques prior to surgery and should be assisted with these devices during sedation and in the postoperative period. Noninvasive ventilation associated with aggressive airway clearance techniques can successfully treat upper airway obstruction, hypoventilation, and airway secretion retention, avoiding prolonged intubation and tracheotomy. Succinylcholine must be avoided in all NMDs except in children with neuromuscular junction diseases. Halogenated agents must be avoided in all children with muscle disease except in patients with mitochondrial myopathies.

This chapter describes anesthestetic and perioperative management of children with neuromuscular disorders.

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Author information

Authors and Affiliations

  1. Anesthesiology and Intensive Care Unit, S.C. Anestesia e Rianimazione Pediatrica Azienda Ospedaliera SS Antonio Biagio e Cesare Arrigo Hospital, Via Venezia 16, Alessandria, 15100, Italy

    Fabrizio Racca MD

  2. Anesthesiology and Intensive Care Unit, SS Antonio Biagio e Cesare Arrigo Hospital, Alessandria, Italy

    Chiara Robba

Authors
  1. Fabrizio Racca MD
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  2. Chiara Robba
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Correspondence to Fabrizio Racca MD .

Editor information

Editors and Affiliations

  1. UCO di Anestesia e Rianimazione, AO-U Policlinico di Catania, Catania, Italy

    Marinella Astuto

  2. MUHC Montreal Children’s Hosp, McGill Un, Department of Anesthesia, Montreal, Canada

    Pablo M Ingelmo

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© 2016 Springer International Publishing Switzerland

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Racca, F., Robba, C. (2016). Perioperative Care of Children with Neuromuscular Disease. In: Astuto, M., Ingelmo, P. (eds) Perioperative Medicine in Pediatric Anesthesia. Anesthesia, Intensive Care and Pain in Neonates and Children. Springer, Cham. https://doi.org/10.1007/978-3-319-21960-8_12

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  • DOI: https://doi.org/10.1007/978-3-319-21960-8_12

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21959-2

  • Online ISBN: 978-3-319-21960-8

  • eBook Packages: MedicineMedicine (R0)

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