Epidemiology and Risk Factors
Diagnostic Approach and DDx
Management
Anaesthetic Considerations
- General
- Low threshold for HDU monitoring
↑ risk of apnoea and death for 24 hours following extubation.
- A
- Limited mouth opening
- Bulbar palsy and aspiration risk
- B
- Respiratory muscle weakness and expectoration
Pulmonary complications are the most common cause of peri-operative morbidity.
- OSA
- C
- Cardiomyopathy
- Conduction abnormalities
- D
- ↑ sensitivity to IV induction agents
- Addition of lignocaine may reduce the incidence of contractures
- Shivering from neuraxial anaesthesia may precipitate myotonic contractures
- Regional techniques ideal to reduce analgesia and opioid requirements
- E
- Hypothermia
Avoid shivering.
- Avoid suxamethonium
May result in severe hyperkalaemia.
- Avoid muscle relaxation where possible
Reduce initial doses and titrate with a nerve stimulator.
- E
- DM
- Hypothyroidism
- Adrenal insufficiency
- Gonadal atrophy
- O
- Neuraxial anaesthesia preferred for labour and caesarian delivery
- Tocolytic medications are problematic
- β2-agonists may precipitate myotonia
- MgSO4 may precipitate respiratory depression
Marginal and Ineffective Therapies