What are the American College of Chest Physicians (ACCP) guidelines for intraoperative respiratory support of patients with Duchenne muscular dystrophy (DMD)?

Updated: Aug 17, 2020
  • Author: Twee T Do, MD; Chief Editor: Jeffrey D Thomson, MD  more...
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Answer

Intraoperative measures include the following:

  • Consider use of a total intravenous anesthesia technique for induction and maintenance of general anesthesia (eg, propofol and short-acting opioids)
  • The use of depolarizing muscle relaxants such as succinylcholine is absolutely contraindicated because of the risk of fatal reactions
  • Have an intensive care unit bed available for postprocedure care

Options for providing respiratory support during maintenance of general anesthesia or procedural sedation for patients with DMD include the following:

  • Endotracheal intubation, with use of NPPV to facilitate extubation for selected patients
  • Mechanical ventilation via a mouthpiece with leak-proof seal
  • Manual or mechanical ventilation (using conventional ventilators or bilevel positive pressure ventilators designed for noninvasive respiratory support) delivered via a full face mask or nasal mask interface
  • Application of ventilation in the assisted or controlled modes should be considered for patients with FVC <50% of predicted, and strongly considered for those with an FVC <30% of predicted

Options for respiratory support during induction of and recovery from general anesthesia or procedural sedation include the following:

  • Manual ventilation using a flow-inflated manual resuscitation bag (standard “anesthesia bag”) with a full face or nasal mask interface
  • Mechanical support using a conventional or noninvasive positive pressure ventilator via a full face or nasal mask

Monitor SpO2 continuously and, whenever possible, blood or end-tidal carbon dioxide levels.


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