Case Report
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 |
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