Question
A 5-year-old boy with Duchenne muscular dystrophy (DMD) is scheduled for a tendon lengthening procedure under general anesthesia. Which of the following is the most appropriate anesthetic technique?
| A. |
Induction with intravenous propofol and maintenance with total intravenous anesthesia (TIVA) using oxygen, opioids, and non-depolarizing muscle relaxants as required
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| B. |
Induction with intravenous succinylcholine (suxamethonium) followed by maintenance with nitrous oxide (N₂O) and oxygen
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| C. |
Inhalational induction with halothane followed by maintenance with nitrous oxide (N₂O) and oxygen
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| D. |
Induction with intravenous propofol followed by maintenance with sevoflurane and oxygen
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Show Answer
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Correct Answer » A
Explanation
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- Total intravenous anesthesia (TIVA) is the preferred anesthetic technique in patients with DMD.
- It avoids exposure to triggering agents associated with anesthesia-induced rhabdomyolysis.
- Preferred agents include:
- Propofol
- Opioids (e.g., fentanyl, remifentanil)
- Non-depolarizing neuromuscular blockers (e.g., rocuronium, vecuronium) if muscle relaxation is required.
- This technique minimizes the risk of:
- Hyperkalemia
- Rhabdomyolysis
- Cardiac arrest
- Malignant hyperthermia-like reactions
Why Other Options are Incorrect
B. Induction with intravenous succinylcholine (suxamethonium) followed by maintenance with nitrous oxide and oxygen
- Succinylcholine is absolutely contraindicated in DMD.
- It can cause:
- Massive potassium release
- Severe rhabdomyolysis
- Cardiac arrest
C. Inhalational induction with halothane followed by maintenance with nitrous oxide and oxygen
- Volatile inhalational anesthetics such as halothane should be avoided.
- They may precipitate anesthesia-induced rhabdomyolysis and life-threatening hyperkalemia.
D. Induction with intravenous propofol followed by maintenance with sevoflurane and oxygen
- Although propofol induction is appropriate, maintenance with a volatile anesthetic (sevoflurane) is not recommended in patients with DMD because of the risk of anesthesia-induced rhabdomyolysis.
