Department of Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Department of Neurology, Cognition and Behaviour, Donders Institute for Brain, Radboud University Medical Center, Nijmegen, The Netherlands.
Can J Anaesth. 2022 Jun;69(6):756-773. doi: 10.1007/s12630-022-02230-3. Epub 2022 Mar 23.
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.
We searched PubMed and EMBASE for articles published between 1 January 2000 and 14 July 2021.
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).
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.
患有神经肌肉疾病（NMDs）的患者围手术期并发症的风险增加。本综述的目的是通过发表的研究、病例报告和综述文章，检查 NMD 患者的麻醉管理方面的新证据，方法是使用范围综述的方法框架。
我们在 PubMed 和 EMBASE 上搜索了 2000 年 1 月 1 日至 2021 年 7 月 14 日期间发表的文章。
纳入了 3 项前瞻性和 21 项回顾性研究，这些研究涉及 NMD 患者神经肌肉阻断剂（NMBA）药代动力学和药效学的改变。此外，还纳入了 168 例病例报告/系列，涉及 197 例患者的 212 次麻醉。这些研究表明，术前神经肌肉监测可用于重症肌无力患者 NMBA 的精确剂量。苏伽地尔与较少的术后肌无力危象相关。围手术期并发症与特定的麻醉剂无关。病例报告/系列显示，在 212 次麻醉中的 32%（67/212）中，至少报告了一种并发症。意外入住重症监护病房是一种经常报告的并发症。疾病过程复杂的患者可能使用过琥珀酰胆碱（未调整的相对风险，0.13；95%置信区间[CI]，0.20 至 0.86）和挥发性麻醉剂（调整后的优势比[OR]，0.38；95%CI，0.20 至 0.73；P = 0.004）的可能性更高。
关于 NMD 患者的麻醉管理和围手术期并发症的证据主要基于小型回顾性研究和病例报告。需要进一步的临床试验或大型回顾性研究来调查安全麻醉剂的选择。主要关注领域是神经肌肉监测和苏伽地尔的潜在益处，以及挥发性麻醉剂和琥珀酰胆碱可能带来的风险。
