Oliviamsutton at 11:02, 22 July 2022

2022-07-22T11:02:16Z

← Older revision		Revision as of 04:02, 22 July 2022
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	\| image =		\| image =
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	\| anesthetic_relevance =		\| anesthetic_relevance = High
	\| specialty =		\| anesthetic_management = Induce with RSI with roc and reverse with sugammadex. Sux, roc, and neostigmine may produce atypical responses.
			\| specialty = MSK
	\| signs_symptoms =		\| signs_symptoms =
	\| diagnosis =		\| diagnosis =
	\| treatment =		\| treatment =
	}}~~Provide~~ a ~~brief summary of this comorbidity here~~.		}}


			There are two types of myotonic dystrophy caused by two mutations in two distinct gene loci: myotonic dystrophy types 1 and 2. Type 1 is a multisystem disease affecting the musculoskeletal system, the heart, the respiratory system, the central nervous system and the endocrine system. Type 2 has similar manifestations, but is less severe.

			Muscle weakness begins distally and progresses proximally, with muscle wasting developing over time.

	==Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. -->==		==Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. -->==
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	===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===		===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->===
			Succinylcholine produces exaggerated contractures severe enough to impair ventilation, and can make intubation/ventilation very difficult. May have enhanced response to NDNMBs due to chronic myopathy. Neostigmine may provoke myotonia. Peripheral nerve stimulators may provoke myotonia.

			The generally preferred option for induction is RSI with rocuronium and eventual reversal with sugammadex.

	===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===		===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->===
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	==Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. -->==		==Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. -->==
			Myotonic dystrophy is theorized to be caused by an abnormality in the intracellular adenosine triphosphate system, causing a failure of calcium to return to the sarcoplasmic reticulum and hence a myotonic response (delayed relaxation of skeletal muscle after voluntary contraction).

	==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->==		==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->==
			MSK: Myotonic responses to voluntary movement.

			Respiratory: Pulmonary function test reveals restrictive lung disease pattern due to contractures of intercostal muscles. Ventilatory response to hypoxia and hypercarbia is impaired. Patients are predisposed to developing pneumonia due to reduced lung volume and ineffective cough mechanism. Patients are especially sensitive to the respiratory depressant effects of common anesthetic medications

			Endocrine: insulin resistance

			Cardiac: defects in cardiac conduction

			CNS: neuropsychiatric impairment

			HEENT: Cataracts, frontal balding in males

			GU: Testicular atrophy.

			Gyn: High incidence of OB complications including polyhydramnios, breech, premature labor, impaired cervical dilation, uterine atony, retained placenta, postpartum hemorrhage. Symptoms are exacerbated by pregnancy due to elevated progesterone levels.

	==Diagnosis<!-- Describe how this comorbidity is diagnosed. -->==		==Diagnosis<!-- Describe how this comorbidity is diagnosed. -->==

Oliviamsutton: Created page with "{{Infobox comorbidity | other_names = | image = | caption = | anesthetic_relevance = | specialty = | signs_symptoms = | diagnosis = | treatment = }}Provide a brief summary of this comorbidity here. ==Anesthetic implications== ===Preoperative optimization=== ===Intraoperative managem..."

2022-07-22T10:51:00Z

Created page with "{{Infobox comorbidity | other_names = | image = | caption = | anesthetic_relevance = | specialty = | signs_symptoms = | diagnosis = | treatment = }}Provide a brief summary of this comorbidity here. ==Anesthetic implications== ===Preoperative optimization=== ===Intraoperative managem..."

New page

{{Infobox comorbidity
| other_names =
| image =
| caption =
| anesthetic_relevance =
| specialty =
| signs_symptoms =
| diagnosis =
| treatment =
}}Provide a brief summary of this comorbidity here.

==Anesthetic implications==

===Preoperative optimization===

===Intraoperative management===

===Postoperative management===

==Related surgical procedures==

==Pathophysiology==

==Signs and symptoms==

==Diagnosis==

==Treatment==

===Medication===

===Surgery===

===Prognosis===

==Epidemiology==

==References==

[[Category:Comorbidities]]

Myotonic muscular dystrophy - Revision history

Oliviamsutton at 11:02, 22 July 2022