TY - JOUR
T1 - Cartographie des données probantes actuelles sur la prise en charge anesthésique des patients adultes atteints de maladies neuromusculaires
T2 - une étude de portée
AU - van den Bersselaar, Luuk R.
AU - Gubbels, Madelief
AU - Riazi, Sheila
AU - Heytens, Luc
AU - Jungbluth, Heinz
AU - Voermans, Nicol C.
AU - Snoeck, Marc M.J.
N1 - Funding Information:
Luuk R. van den Bersselaar contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Madelief Gubbels contributed to the conception and design of the study; acquisition, and interpretation of data; and drafting the article. Sheila Riazi contributed to conception of the study, interpretation of data, and drafting the article. Luc Heytens contributed to the interpretation of data and drafting the article. Heinz Jungbluth contributed to conception of the study, interpretation of data, and drafting the article. Nicol C. Voermans contributed to the conception and design of the study, interpretation of data, and drafting the article. Marc M. J. Snoeck contributed to the conception and design of the study, interpretation of data, and drafting the article. This manuscript was written with support of the European Neuromuscular Centre (ENMC) and was performed in preparation for the 259thENMC workshop in December 2020. Several authors of this publication are members of the Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases (EURO-NMD). The authors thank OnYing Chan for her help with developing the search strategy. The authors thank Karlijn Bouman and Flavien Bizot for their help with translation of the abstract. The authors thank Jeroen van Doorn for his help with the statistical analysis. The authors of this scoping review, the organizers and participants of the 259thENMC workshop, and all others involved in this scoping review do not have any conflicts of interest to declare. Luuk van den Bersselaar received the 2019 Radboudumc Regional Junior Researcher Grant, in collaboration with the Canisius Wilhelmina Hospital. This scoping review was written in preparation for the 259th European Neuromuscular Centre international workshop: Anesthesia and neuromuscular disorders December 11, 2020 and May 28–29, 2021. The workshop was financially supported by the European Neuromuscular Centre. This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.
Funding Information:
Luuk van den Bersselaar received the 2019 Radboudumc Regional Junior Researcher Grant, in collaboration with the Canisius Wilhelmina Hospital. This scoping review was written in preparation for the 259th European Neuromuscular Centre international workshop: Anesthesia and neuromuscular disorders December 11, 2020 and May 28–29, 2021. The workshop was financially supported by the European Neuromuscular Centre.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - anesthesia
KW - malignant hyperthermia
KW - myopathy
KW - neuromuscular disorders
KW - perioperative adverse events
UR - http://www.scopus.com/inward/record.url?scp=85126853713&partnerID=8YFLogxK
U2 - 10.1007/s12630-022-02230-3
DO - 10.1007/s12630-022-02230-3
M3 - Review article
AN - SCOPUS:85126853713
SN - 0832-610X
VL - 69
SP - 756
EP - 773
JO - Canadian Journal of Anaesthesia
JF - Canadian Journal of Anaesthesia
IS - 6
ER -