From the Research
For anesthesia in patients with Charcot-Marie-Tooth disease (CMT), use caution with neuromuscular blocking agents and regional anesthesia, as recommended by the most recent study 1. When managing anesthesia for CMT patients, several key considerations must be taken into account to minimize potential complications and ensure effective anesthesia.
- Avoid succinylcholine due to the risk of hyperkalemia, and instead use reduced doses of non-depolarizing muscle relaxants, such as rocuronium or cisatracurium, at 50-75% of the usual dose, with close neuromuscular monitoring 1.
- Regional anesthesia can be used but requires careful assessment due to the potential for nerve damage, and if employed, use ultrasound guidance and lower concentrations of local anesthetics 2.
- Maintain normothermia as CMT patients are prone to hypothermia, using warming devices and monitoring core temperature closely 3.
- Be prepared for possible respiratory complications, as CMT patients may have reduced respiratory muscle strength, and ensure careful postoperative monitoring and consider early extubation criteria 1.
- Avoid medications that can exacerbate neuropathy, such as metoclopramide or high-dose vincristine, to prevent further nerve damage 4. These precautions are necessary because CMT affects peripheral nerves, leading to muscle weakness and sensory loss, and can alter drug responses, particularly to neuromuscular blockers, increasing susceptibility to nerve injury during positioning or regional techniques 5. The goal is to minimize potential complications while providing effective anesthesia, and the most recent study 1 supports this approach, highlighting the importance of careful anesthetic planning and management in CMT patients.