Muscular dystrophy

 

Issues:

Airway

·         Macroglossia

·         Bulbar weakness

·         Reduced GIT motility

·         Impaired cough reflex

·         Recurrent aspiration

Breathing

·         T2RF

·         OSA

·         Scoliosis

·         Opioid sensitivity ??

Circulation

·         Conduction disease

·         Cardiomyopathy

·         Mitral regurgitation

Disability

·         Mild intellectual disability common

Drugs

·         MH-like / rhabdo: avoid volatiles and sux

·         Sensitive to hypnotics

·         Sensitive to non-depolarising relaxants

 

Preventing respiratory failure:

Pre-op

·         RFT for stratificiation

·         Optimise if possible

Intra-op

·         Extubate in theatre

·         Sitting bolt upright

·         Straight onto BiPAP

Post-op

·         HDU

·         Pain service – multi-modal, regional preferred

·         Chest physio

 

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