A 5 year old boy suffering from Duchenne muscular dystrophy and polymyositis has been fasting for 8 hour and has to undergo tendon lengthening procedure. Which anaesthetics should be used?
A halogenated anesthetic agent alone may trigger an episode of malignant hypehermia (MH) in patients with Duchenne's and other muscular dystrophies, nonspecific myopathies, heat stroke, and osteogenesis imperfecta. Drugs Known to Trigger Malignant Hypehermia: Inhaled general anesthetics Ether Halothane Methoxyflurane Enflurane Isoflurane Desflurane Sevoflurane Nondepolarizing muscle relaxants Succinylcholine Ref: Butterwoh IV J.F., Butterwoh IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C., Wasnick J.D. (2013). Chapter 52. Thermoregulation, Hypothermia, & Malignant Hypehermia. In J.F. Butterwoh IV, J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e.
Induction by I.V. scoline and N20 halothane for maintenance
Induction by I.V. propofol, N20 and O2 for maintenance
Induction by I.V. thiopentone and N20 and halothane for maintenance
Inhalational N20, halothane and O2 for maintenance