Anesthetic Considerations in a Patient with Myotonic Dystrophy for Hip Labral Repair

Table 2

Summary of DM effects and practice suggestions for perioperative management of patients with DM.

Organ system	Effect	Plan
Central Nervous System	(i) Temperature regulation; (ii) Increased risk of corneal abrasions from proptosis	(i) Keep patient warm; (ii) Increase temperature in operating room; (iii) Careful taping of eyes, ophthalmic ointment
Behavioral issues	(i) Cognitive dysfunction; (ii) Behavioral issues; (a) Anxiety; (b) Bipolar disorder; (c) Obsessive- compulsive disorder	(i) Check for mood altering medications; (ii) Use small 0.5 mg to 1 mg boluses of benzodiazepines to assess patient’s sensitivity
Endocrine	(i) Diabetes; (ii) Hyperthyroid; (iii) Hyperparathyroid	(i) Check AM blood sugar; (ii) Preop thyroid function testing; (iii) Check calcium level preoperatively
Cardiac	(i) Arrhythmias: (a) Atrial flutter; (b) Atrial fibrillation	(i) Have defibrillator available and pads on patient; (ii) Interrogate AICD if present
Pulmonary	(i) Impairment of ventilation and sensitivity to respiratory depressants; (ii) Ineffective coughing; (a) Aspiration pneumonia	(i) Minimize use respiratory depressants; (ii) Aggressive postoperative pulmonary hygiene
Musculoskeletal	(i) Involuntary muscle contraction, progressive weakness	(i) Avoid triggering agents: (a) Succinylcholine; (b) Neostigmine
Gastrointestinal	(i) Prolonged gastric emptying	(i) Consider rapid sequence induction and intubation