Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 11. Evaluation of the Patient with Neuromuscular or Skeletal Disease Philip D. Bailey, Jr., DO, and Joseph R. Tobin, MD

Key Points

"1. The major cause of death in patients with neuromuscular disorders is respiratory insufficiency. Respiratory involvement often varies considerably among the various neuromuscular disorders, and the extent of general muscle weakness does not necessarily correlate with the severity of respiratory muscle involvement.

2. Cardiovascular involvement in patients with neuromuscular disorders may manifest as myocardial failure in patients with myopathic disorders and as autonomic dysfunction in patients with neuropathic disorders. Clinical signs of autonomic dysfunction include orthostatic hypotension, resting tachycardia, paralytic ileus, anhidrosis, and constricted pupils. The presence of these clinical signs may indicate profound hemodynamic instability that may manifest during the perioperative period, requiring invasive monitoring to manage the patient's volume status and ventricular contractility.

3. In patients with neuromuscular disorders, the severity of skeletal muscle involvement does not necessarily correlate with the severity of cardiac involvement.

4. Children with asymptomatic, undiagnosed muscular dystrophy are at significant risk for serious, life-threatening anesthetic complications. Specifically, these patients may develop intractable hyperkalemic cardiac arrest after receiving succinylcholine intravenously.

5. Spinal anesthesia has been associated with exacerbation of multiple..."