Anestesia em paciente portador de distrofia muscular de Duchenne. Relato de casos

Abstract

BACKGROUND AND OBJECTIVES:Reporting two cases of anes-thesia in Duchenne Muscular Dystrophy (DMD) patients, which is anuncommon, progressive and disabling disease, and discussinganesthetic approaches, impairment of pulmonary and cardiac func-tions, the possibility of malignant hyperthermia, increased sensitivityto neuromuscular blockers and increased postoperative morbidityare some challenges faced by anesthesiologists.CASE REPORTS: First case was a pediatric patient with DMDand rhabdomyosarcoma, scheduled for tumor excision and cervi-cal emptying. During preanestheticevaluation, history, clinicaland additional exams, no changes were detected except for thecervical tumor. We decided for total intravenous anesthesia withremifentanil administered by continuous infusion and propofol bytarget-controlled infusion without neuromuscular blockers. Sur-gery lasted 180 minutes without intercurrences. The second casewas a male patient, 24 years old, with DMD and cholelithiasis withsurgical indication who, during preoperative evaluation, has re-vealed severe restrictive pneumopathy with decreased capacityand respiratory reserves and the need for nasal BIPAP at night.For this patient we decided for tracheal intubation with minimumsedation and topic anesthesia, followed by total intravenous an-esthesia with remifentanil administered by continuous infusionand propofol by target-controlled infusion without neuromuscularblockers. At the end, patient was extubated still in to operatingroom and nasal BIPAP was immediately placed, being patient re-ferred to the ICU. Patient was discharged from ICU in the 2ndPOday and from hospital in the 3rdPO day.CONCLUSIONS:Total intravenous anesthesia with propofol andremifentanil administered by continuous infusion withoutneuromuscular blockers is a safe and effective option for DMD pa-tients