Prottengeier J, Amann B, Münster T
Anästhesiologische Klinik, Universitätsklinikum Erlangen, Krankenhausstr. 12, 91054, Erlangen, Deutschland.
Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
Anaesthesist. 2020 Jun;69(6):373-387. doi: 10.1007/s00101-020-00738-1.
Neuromuscular diseases (NMD) are a heterogeneous group of motor unit disorders. Common to all is the main clinical symptom of muscle weakness. Depending on entity and phenotype, a broad range of disorders of neuronal, junctional or myocytic structures occurs. In addition to a weakness of the skeletal musculature, NMD can also affect throat musculature, respiratory and heart muscles. The possible consequences are immobility, deformities, tendency to aspiration as well as respiratory and cardiac insufficiency. In the context of surgery and anesthesia, complications that can result from the underlying disease and its interaction with anesthesia must be anticipated and averted. This article describes along the treatment pathway how preoperative evaluation, choice of the anesthetic procedure and postoperative care can be effectively and safely tailored to the needs of patients with NMD. Concise and practical recommendations for carrying out anesthesia for the most important NMDs are presented as well as relevant external sources of practice recommendations.
神经肌肉疾病(NMD)是一组异质性的运动单位疾病。所有这些疾病的共同主要临床症状是肌肉无力。根据疾病实体和表型,会出现广泛的神经元、神经肌肉接头或肌细胞结构紊乱。除了骨骼肌无力外,NMD还可影响咽喉肌肉、呼吸肌和心肌。可能的后果是活动受限、畸形、误吸倾向以及呼吸和心脏功能不全。在手术和麻醉过程中,必须预见并避免由基础疾病及其与麻醉的相互作用可能导致的并发症。本文沿着治疗路径描述了如何根据NMD患者的需求有效且安全地调整术前评估、麻醉方法的选择和术后护理。还介绍了针对最重要的NMD进行麻醉的简明实用建议以及相关的外部实践建议来源。