Problems of Anesthesia in Patients With Neuromuscular Disease

Patients with weak muscles fall into three broad categories based on the site of pathology: neurogenic (cell body or nerve fiber), myopathic (intrinsic muscle), or neuromuscular transmission (neuromuscular junction) abnormalities. This review is divided into these three causal divisions. General principles for the anesthesiologist to understand the pathophysiology of neuromuscular diseases and to manage these patients safely in the perioperative period are described. Although malignant hyperthermia (MH) is obviously an important muscle disorder, its inheritance and anesthetic management have been extensively described elsewhere, 3 , 16 , 28 , 30 , 31 , 46 and are beyond the scope of this article. MH will be considered here only in the context of its relationship to other neuromuscular disorders. Unfortunately, all of the disorders addressed in this article can neither be fully explained nor their anesthetic management completely rationalized based on this naive model; however, the authors have attempted to use this framework to categorize the various disease states which can result in clinical weakness and summarize the anesthetic management of each.