Abstract
The purpose of this retrospective study was to estimate the frequency and severity of anaesthetic complications in patients with Duchenne’s muscular dystrophy (DMD). Forty-four boys with DMD were exposed to anaesthesia and surgery 84 times during a period of 22 years (1965–86). The procedures took place at 15 different hospitals. Retrospective examination of the case records showed: 19 cases with local analgesia without any complications, and 18 of 65 general anaesthetics with minor or more serious complications. In ten cases an increase in body temperature above 37.5° C was seen, five had abdominal pain and dark-coloured urine after surgery, and three had a critical perioperative course with a resemblance to malignant hyper-thermia. The complications were almost exclusively related to the use of succinylcholine. The use of succinylcholine was dispersed through all ages. Three out of the eight patients with severe complications occurred 1.5, 2.5 and 4 years before the neuromuscular disease was diagnosed. Thus an unusual course of anaesthesia in male children calls for further investigation. Although it has been stated before that succinylcholine is contraindicated in patients with Duchenne’s muscular dystrophy, the drug continues to be used.
Résumé
Cette étude rétrospective visait à déterminer l’incidence et la gravité des complications survenant en cours d’ anesthésie chez les victimes de la dystrophie musculaire de Duchenne (DMD). Nous avons revu les dossiers de 84 interventions faites chez 44 garcons atteints, dans 15 hôpitaux entre 1965 et 1986. Les 19 interventions sous anesthésie locale s’étaient déroulées sans problème mais nous avons identifié 18 complications lors des 65 anaesthésies générales. En dix occasions, la température s’etait élevée au delà de 37.5° C, accompagnée dans cinq cas, de douleurs abdominales et d’ urines foncées après l’intervention et dans trois cas, d’une période péri-opératoire mouvementée ressemblant à de l’hyperthermie maligne. Ces complications étaient systématiquement associées à l’usage de la succinyl-choline, prévalent quel que soit l’age. Trois des huit incidents majeurs se sont produits 1.5, 2.5 et 4 ans avant que le diagnostic de DMD ne soit posé, ainsi, toute anesthésie compliquée chez un garçon devrait éveiller les soupçons. Par ailleurs, nous déplorons l’usage persistant de la succinylcholine chez les malades atteints de dystrophie musculaire de Duchenne et ce, malgré les nombreuses mises en garde.
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Larsen, U.T., Juhl, B., Hein-Sørensen, O. et al. Complications during anaesthesia in patients with Duchenne’s muscular dystrophy (a retrospective study). Can J Anaesth 36, 418–422 (1989). https://doi.org/10.1007/BF03005341
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DOI: https://doi.org/10.1007/BF03005341