Muscular dystrophy (Duchenne/Becker)

Top concerns

1. 1.Succinylcholine is absolutely contraindicated: hyperkalemic cardiac arrest and rhabdomyolysis
2. 2.Volatile agents are associated with anesthesia-induced rhabdomyolysis (a distinct, MH-like emergency) — TIVA is the prudent default in DMD
3. 3.Cardiomyopathy is near-universal with disease progression and underestimated by activity level (they can't exercise enough to show symptoms) — recent echo/cardiology input preop
4. 4.Restrictive respiratory disease: assess cough strength and consider postoperative ventilation needs; extubation planning starts preop
5. 5.Sensitive to nondepolarizing NMBDs with markedly prolonged recovery — quantitative monitoring + sugammadex for rocuronium
6. 6.GI hypomotility raises aspiration consideration

Drug do's and don'ts

• AVOIDSuccinylcholine— Hyperkalemic arrest — no exceptions.
• AVOIDVolatile anesthetics (DMD)— Rhabdomyolysis/hyperkalemia association — prefer TIVA.
• PREFERTIVA (propofol-based)— Standard trigger-free approach; titrate against myocardial depression.

Airway & positioning

• Weak cough + possible macroglossia (later disease) — plan suction, staged extubation criteria
• Contractures and scoliosis complicate positioning — pad and support deliberately

Pearls

• An unexplained arrest in a boy under 8 is a myopathy/hyperkalemia story — that's why sux left routine pediatric practice.
• Treat the echo as expired if it predates functional decline.

Suggested reading

• Coté, 6e
• Stoelting's Anesthesia and Co-Existing Disease, 8e

Educational quick-reference only — defer to clinical judgment, institutional protocols, and the primary texts above.