What are CDC guidelines for surgical precautions for 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

The CDC guidelines concur with the earlier guidelines of ACCP and include these additional recommendations for surgical precautions [73] :

  • Surgery should be performed in a full-service hospital that has experience with DMD patients
  • For patients on  long-term corticosteroid treatment, consider steroid coverage over the period of surgery
  • To minimize blood loss and its intraoperative effects in major surgeries (eg, spinal fusion), use mildly hypotensive anesthetics, crystalloid bone allograft, and cell-saver technology
  • Other interventions, such as the use of aminocaproic acid or tranexamic acid to diminish intraoperative bleeding, can be considered
  • Postoperative anticoagulation with heparin and/or aspirin is inappropriate
  • Use of compression stockings or sequential compression for prevention of deep venous thrombosis may be indicated
  • An echocardiogram and electrocardiogram should be done before general anesthesia
  • An echocardiogram should also be done if the patient is undergoing conscious sedation or regional anesthesia if the last investigation was more than 1 year ago or the patient has had an abnormal echocardiogram in the preceding 7-12 months
  • For local anesthesia, an echocardiogram should be done if an abnormal result had been obtained previously
  • Incentive spirometry is not indicated owing to potential lack of efficacy in patients with respiratory muscle weakness and the availability of preferred alternatives, such as mechanical insufflation-exsufflation (MI-E)

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