A Review of Muscle Relaxants in Anesthesia in Patients with Neuromuscular Disorders Including Guillain-Barré Syndrome, Myasthenia Gravis, Duchenne Muscular Dystrophy, Charcot-Marie-Tooth Disease, and Inflammatory Myopathies

Abstract

Anesthesia management in neuromuscular diseases (NMDs) is a complex challenge, requiring careful preoperative evaluation, tailored treatment strategies, and vigilant perioperative monitoring. This review examines the nuances of anesthesia in patients with NMD, addressing potential complications such as intubation difficulties, respiratory failure, and adverse effects of anesthetics and neuromuscular conduction blocking agents (NMBAs). Nondepolarizing NMBAs, including steroidal agents and benzylisoquinolines, are analyzed for their role, risks, and optimal use based on procedural requirements and patient characteristics. Challenges with depolarizing agents such as succinylcholine are highlighted, emphasizing the need for careful evaluation and monitoring to reduce the risk of adverse events such as malignant hyperthermia and hyperkalemia. The review highlights the role of reversal agents, particularly sugammadex, as a safer and more effective alternative to traditional acetylcholinesterase inhibitors such as neostigmine. Sugammadex reduces the risk of complications such as prolonged paralysis and respiratory failure in patients with NMD. In addition, anesthesia considerations tailored to specific NMDs, including Guillain-Barre syndrome, myasthenia gravis, Duchenne muscular dystrophy, Charcot-Marie-Tooth disease, and inflammatory myopathies are presented, including monitoring techniques and individualized approaches. Based on the available literature and the authors' clinical experience, this review aims to discuss the role of muscle relaxants in anesthesia in patients with the aforementioned neuromuscular disorders. This document uses the latest possible articles, covering items from 1992 to 2024.