Cartographie des données probantes actuelles sur la prise en charge anesthésique des patients adultes atteints de maladies neuromusculaires : une étude de portée

Translated title of the contribution: Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Luuk R. van den Bersselaar*, Madelief Gubbels, Sheila Riazi, Luc Heytens, Heinz Jungbluth, Nicol C. Voermans, Marc M.J. Snoeck

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)

Abstract

Purpose: Patients with neuromuscular disorders (NMDs) are at increased risk of perioperative complications. The objective of this scoping review was to examine emerging evidence from published studies, case reports, and review articles on anesthetic management of patients with NMDs, following the methodological frame for scoping reviews. Sources: We searched PubMed and EMBASE for articles published between 1 January 2000 and 14 July 2021. Principal findings: Three prospective and 21 retrospective studies on altered pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBA) in NMD patients were included. Furthermore, 168 case reports/series reporting 212 anesthetics in 197 patients were included. These studies showed that preanesthetic neuromuscular monitoring can be used for precise NMBA dosing in myasthenia gravis patients. Sugammadex was associated with fewer postoperative myasthenic crises. Perioperative complications were not associated with specific anesthetic agents. Case reports/series showed that in 32% (67/212) of anesthetics, at least one complication was reported. Unexpected intensive care unit admission was a frequently reported complication. Patients with a complicated disease course may have had a higher use of succinylcholine (unadjusted relative risk, 0.13; 95% confidence interval [CI], 0.20 to 0.86) and volatile anesthetics (adjusted odds ratio [OR], 0.38; 95% CI, 0.20 to 0.73; P = 0.004). Conclusion: Evidence on the anesthetic management and perioperative complications of patients with NMDs is mainly based on small retrospective studies and case reports. Further clinical trials or large retrospective studies are required to investigate the choice of safe anesthetic agents. Main areas of interest are the potential benefits of neuromuscular monitoring and sugammadex and the risks possibly associated with volatile anesthetics and succinylcholine.

Translated title of the contributionMapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review
Original languageFrench
Pages (from-to)756-773
Number of pages18
JournalCanadian Journal of Anesthesia
Volume69
Issue number6
DOIs
Publication statusPublished - Jun 2022

Keywords

  • anesthesia
  • malignant hyperthermia
  • myopathy
  • neuromuscular disorders
  • perioperative adverse events

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