|
| Drug | Use in DM | Adverse effects/complications | Other effects |
|
| Propofol | Demonstrated to be safe in many reported cases [2, 14, 15] | Can induce myotonia [16, 17]
Prolonged recovery after targeted controlled infusions. [11] | Sensitivity is altered. Less than 1mg/kg has been shown to be enough to induce general anesthesia and intubation by Speedy et al. [16] |
|
| Thiopentone | Has been used in multiple case reports/series without any adverse event [18]. | Shown to result in unexpected apnea/prolonged respiratory depression [3, 13] | Prolonged apnea due to thiopentone seems to be idiosyncratic. |
|
| Etomidate | Use has been described before [19] | Continuous infusion not recommended due to steroid suppression [2, 20]. | |
|
| Volatile Anesthetics | Has been reported to be used with success [21] | Concern with deep inhalation anesthesia leading to shivering and compromised cardiac status | Some reluctance to use initially due to association with malignant hyperthermia (MH). But recent literature showed DM patients are no more susceptible to MH than general population. [22, 23] |
|
| Muscle relaxants | Shorter and intermediate acting nondepolarizing agents are safe to be used.
Atracurium has been described to be used without reversal agent or prolonged muscle weakness [24]. | Depolarizing muscle relaxants has been shown to induce myotonia leading to inability to ventilate and maintain the airway [3, 25].
Longer acting nondepolarizing agents have been shown to add to the weakness/respiratory depression. [25]. | Avoidance of muscle relaxants, if possible, is recommended. |
|
| Reversal agents | Sugammadex has been reported to be safe and has been used multiple times in recent past [26]. | Incomplete reversal and postoperative breathing difficulties have been noted in multiple case reports where neostigmine was used [18] | Avoid use of anticholinesterases for reversal [27], exact mechanism not known. |
|
| Dexmedetomidine | Successful use of dexmedetomidine also has been reported to provide opioid free anesthesia in many recent case reports [8] | none reported | |
|
| Opioids | Use of shorter acting opioids is recommended for intraoperative period. | Higher risk of respiratory depression.
Higher risk of postoperative ileus. | Avoid opioids in preoperative and postoperative period. |
|
| Total intravenous anesthesia | Use of propofol and remifentanil infusion have been reported before in cases of DM [13, 28] | Remifentanil has been linked to postoperative hyperalgesia [29]. | |
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