Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis
BackgroundPatients with duchenne muscular dystrophy (DMD) have an increased risk of complications when they undergo sedation or general anesthesia. However, due to improvements in cardiopulmonary therapies during anesthetic care, patients with DMD are experiencing an unprecedented duration of surviv...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-01-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1497538/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832584994258681856 |
|---|---|
| author | Xianghong Lian Xianghong Lian Xianghong Lian Yang Jing Yang Jing Yang Jing Ting Luo Ting Luo Ting Luo Yixin Guo Yixin Guo Yixin Guo Yunzhu Lin Yunzhu Lin Yunzhu Lin |
| author_facet | Xianghong Lian Xianghong Lian Xianghong Lian Yang Jing Yang Jing Yang Jing Ting Luo Ting Luo Ting Luo Yixin Guo Yixin Guo Yixin Guo Yunzhu Lin Yunzhu Lin Yunzhu Lin |
| author_sort | Xianghong Lian |
| collection | DOAJ |
| description | BackgroundPatients with duchenne muscular dystrophy (DMD) have an increased risk of complications when they undergo sedation or general anesthesia. However, due to improvements in cardiopulmonary therapies during anesthetic care, patients with DMD are experiencing an unprecedented duration of survival. We performed a systematic analysis to assess the benefits and risks of pharmacological interventions for the management of anesthesia and sedation in DMD patients.MethodsWe included any type of study reporting any drug intervention to manage anesthesia and sedation in participants previously diagnosed with DMD. Our primary outcomes were the onset time, recovery time, and neurodevelopmental disabilities. Seven electronic databases and three clinical trial registry platforms were searched. Data from the eligible studies were combined to calculate pooled risk ratios or standardized mean differences, and some included studies are presented in a narrative synthesis.ResultsForty studies with 196 DMD participants were included in the analysis. Compared with those of the control group, the sensitivity of patients with DMD to neuromuscular blocking agents (NMBAs) may have resulted in a prolonged onset time [MD = −0.96, 95% CI (0.71, 2.60), I2 = 33%, P < 0.0001] and recovery time [MD = 2.22, 95% CI (1.14, 3.30), I2 = 76%, P < 0.0001] from anesthesia. The neuromuscular blocking effects showed a significant age dependence in DMD patients, and the safe use of 2 mg/kg sugammadex to antagonize deep neuromuscular blockade and rapid recovery has been reported. Furthermore, DMD patients are at risk of developing malignant hyperpyrexia with general/inhaled anesthesia, and dantrolene is often used for effective rescue. In addition, general anesthesia and central neuraxial blockade in patients with severe DMD are unsafe because respiratory depression and myocardial complications may occur after the administration of volatile anesthetics and depolarizing muscle relaxants (succinylcholine) during the induction of anesthesia.ConclusionsPatients with DMD are more sensitive to NMBAs with delayed onset times and prolonged recovery times. Precautions for DMD patients should include quantitative neuromuscular monitoring, electrocardiographic monitoring and rapid airway protection throughout anesthesia. Compared with general anesthesia, regional anesthesia may be a relatively safe option. |
| format | Article |
| id | doaj-art-5c6382f8eaf7400d8f6bd46e958b8495 |
| institution | Kabale University |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-5c6382f8eaf7400d8f6bd46e958b84952025-01-27T06:40:36ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-01-011210.3389/fmed.2025.14975381497538Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysisXianghong Lian0Xianghong Lian1Xianghong Lian2Yang Jing3Yang Jing4Yang Jing5Ting Luo6Ting Luo7Ting Luo8Yixin Guo9Yixin Guo10Yixin Guo11Yunzhu Lin12Yunzhu Lin13Yunzhu Lin14Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, ChinaEvidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, ChinaEvidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, ChinaEvidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, ChinaEvidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaDepartment of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, ChinaEvidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, ChinaKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, ChinaBackgroundPatients with duchenne muscular dystrophy (DMD) have an increased risk of complications when they undergo sedation or general anesthesia. However, due to improvements in cardiopulmonary therapies during anesthetic care, patients with DMD are experiencing an unprecedented duration of survival. We performed a systematic analysis to assess the benefits and risks of pharmacological interventions for the management of anesthesia and sedation in DMD patients.MethodsWe included any type of study reporting any drug intervention to manage anesthesia and sedation in participants previously diagnosed with DMD. Our primary outcomes were the onset time, recovery time, and neurodevelopmental disabilities. Seven electronic databases and three clinical trial registry platforms were searched. Data from the eligible studies were combined to calculate pooled risk ratios or standardized mean differences, and some included studies are presented in a narrative synthesis.ResultsForty studies with 196 DMD participants were included in the analysis. Compared with those of the control group, the sensitivity of patients with DMD to neuromuscular blocking agents (NMBAs) may have resulted in a prolonged onset time [MD = −0.96, 95% CI (0.71, 2.60), I2 = 33%, P < 0.0001] and recovery time [MD = 2.22, 95% CI (1.14, 3.30), I2 = 76%, P < 0.0001] from anesthesia. The neuromuscular blocking effects showed a significant age dependence in DMD patients, and the safe use of 2 mg/kg sugammadex to antagonize deep neuromuscular blockade and rapid recovery has been reported. Furthermore, DMD patients are at risk of developing malignant hyperpyrexia with general/inhaled anesthesia, and dantrolene is often used for effective rescue. In addition, general anesthesia and central neuraxial blockade in patients with severe DMD are unsafe because respiratory depression and myocardial complications may occur after the administration of volatile anesthetics and depolarizing muscle relaxants (succinylcholine) during the induction of anesthesia.ConclusionsPatients with DMD are more sensitive to NMBAs with delayed onset times and prolonged recovery times. Precautions for DMD patients should include quantitative neuromuscular monitoring, electrocardiographic monitoring and rapid airway protection throughout anesthesia. Compared with general anesthesia, regional anesthesia may be a relatively safe option.https://www.frontiersin.org/articles/10.3389/fmed.2025.1497538/fullDuchenne muscular dystrophysedativeanesthesiapharmacological interventionssystematic reviewmeta-analysis |
| spellingShingle | Xianghong Lian Xianghong Lian Xianghong Lian Yang Jing Yang Jing Yang Jing Ting Luo Ting Luo Ting Luo Yixin Guo Yixin Guo Yixin Guo Yunzhu Lin Yunzhu Lin Yunzhu Lin Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis Frontiers in Medicine Duchenne muscular dystrophy sedative anesthesia pharmacological interventions systematic review meta-analysis |
| title | Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis |
| title_full | Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis |
| title_fullStr | Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis |
| title_full_unstemmed | Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis |
| title_short | Pharmacological interventions for the management of anesthesia and sedation in patients with Duchenne muscular dystrophy: a systematic review and meta-analysis |
| title_sort | pharmacological interventions for the management of anesthesia and sedation in patients with duchenne muscular dystrophy a systematic review and meta analysis |
| topic | Duchenne muscular dystrophy sedative anesthesia pharmacological interventions systematic review meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1497538/full |
| work_keys_str_mv | AT xianghonglian pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT xianghonglian pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT xianghonglian pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yangjing pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yangjing pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yangjing pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT tingluo pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT tingluo pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT tingluo pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yixinguo pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yixinguo pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yixinguo pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yunzhulin pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yunzhulin pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis AT yunzhulin pharmacologicalinterventionsforthemanagementofanesthesiaandsedationinpatientswithduchennemusculardystrophyasystematicreviewandmetaanalysis |