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Abstract

Editor, We appreciate the interest and comments of Errando and Perez-Caballero1 concerning our paper on the anaesthetic management of patients with Duchenne muscular dystrophy2 and are grateful for the opportunity to reply. We agree with Errando and Perez-Caballero that the use of neuromuscular blocking agents in patients with Duchenne muscular dystrophy is of major concern. In our review, we considered many important points arising during anaesthesia and the perioperative period when treating patients with Duchenne muscular dystrophy. It is correct that we have not addressed in detail the use of neuromuscular blocking drugs and reversal agents. However, in the past, we have published several investigations regarding the use of neuromuscular blocking agents in patients with Duchenne muscular dystrophy.3–6 In addition, in one investigation, we reported on the efficacy of pyridostigmine to reverse rocuronium-induced neuromuscular block in patients with Duchenne muscular dystrophy after spinal surgery.7 In group A of our review (patients with minor surgery of the lower extremity), there was no case documented requiring postoperative ventilatory support whether or not neuromuscular blocking drugs had been used. In contrast, following major orthopaedic surgery, many factors influence weaning from the ventilator in patients with Duchenne muscular dystrophy. Apart from the strength of respiratory muscles mentioned by Errando and Perez-Caballero, parameters like perioperative blood loss, cardiac performance, need for sympathomimetic drugs, body temperature and others must be considered when deciding on the time of extubation. On average after spinal surgery, patients reported in our review were ventilated postoperatively for a duration of 19 h. Therefore, we do not routinely use reversal agents before removing the tracheal tube after spinal surgery. We have no experience with the use of sugammadex in patients with Duchenne muscular dystrophy. Acknowledgements Assistance with the letter: none declared. Financial support and sponsorship: none declared. Conflicts of interests: none declared.