Patients with existing neuromuscular diseases require special considerations when undergoing neuromuscular blockade. These diseases include, but are not limited to: multiple sclerosis, seizure disorders, Guillain–Barré syndrome, Parkinson disease, Alzheimer disease, autonomic dysfunction, and syringomyelia.
In a case involving multiple sclerosis, it is important to avoid depolarizing agents such as succinylcholine to avoid hyperkalemia. This is particularly important in patients with paralysis or paresis, as the upregulation of extra-junctional receptors may cause hyperkalemic arrest.
For cases involving seizure disorders, it is important to inquire regarding a patient’s current medications list. Many antiepileptic medications increase the rate of metabolism of nondepolarizing agents. Consequently, frequent redosing might be required to maintain adequate blockade.
As in multiple sclerosis, when managing a case with Guillain–Barré, one should avoid using depolarizing agents such as succinylcholine because of possible hyperkalemia.
In general, patients with Parkinson disease tolerate neuromuscular blockade without complications. Although rare, use of succinylcholine should still be avoided due to theoretical hyperkalemia.
No special consideration is needed with Alzheimer patients for neuromuscular blockade. When using reversal agents, glycopyrrolate is preferred to atropine since atropine is centrally acting and can lead to postoperative confusion. Glycopyrrolate does not cross the blood–brain barrier.
No special consideration needs to be taken in terms of neuromuscular blockade.
Many patients with syringomyelia have existing neurologic deficits as well as pulmonary compromise. Therefore, adequate reversal of neuromuscular blockade is especially important in cases involving this disease. As in most neuromuscular diseases, succinylcholine should be avoided due to hyperkalemia.