Perioperative Care for Patients with Neuromuscular Disorders in the Netherlands – A Questionnaire Study Among Anaesthesiologists, Neurologists and Clinical Geneticists

Article type: Research Article

Authors: van den Bersselaar, L.R.^{a; b; *} | Gubbels, M.H.M.^b | Jungbluth, H.^{c; d} | Schouten, M.I.^e | van der Kooi, A.J.^f | Quinlivan, R.^g | Scheffer, G.J.^h | Riazi, S.ⁱ | Snoeck, M.M.J.^a | Voermans, N.C.^b

Affiliations: [a] Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands | [b] Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands | [c] Department of Paediatric Neurology, Neuromuscular Service, Evelina’s Children Hospital, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom | [d] Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King’s College London, London, United Kingdom | [e] Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands | [f] Department of Neurology, Amsterdam University Medical Center, Neuroscience institute, Amsterdam, The Netherlands | [g] MRC Centre for Neuromuscular Diseases, National Hospital, UCL Queen Square Institute of Neurology, London, United Kingdom | [h] Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands | [i] Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada

Correspondence: [*] Correspondence to: Luuk R van den Bersselaar, Weg door Jonkerbos 100, 6532 SZ, Nijmegen. Tel./Fax: +31 24 365 87 02; Fax: +31 24 365 87 02; E-mail: Luuk.vandenbersselaar@radboudumc.nl.

Abstract: Background:Patients with neuromuscular disorders are at increased risk of suffering perioperative complications. Current knowledge concerning this topic is based on small retrospective studies and expert opinion. Therefore, an individualized multidisciplinary approach to perioperative anaesthesia planning is invaluable to anticipate difficulties and to optimize outcomes. Objective:To evaluate current practice regarding preoperative counselling and perioperative care of neuromuscular patients, with the aim to facilitate standardization and improvement of perioperative care for neuromuscular patients. Methods:A questionnaire-based cross-sectional, observational study was conducted between July, 1st 2020 and December, 31st, 2020 in Dutch anaesthesia, neurology and clinical genetics departments. Main outcome measures were 1.) frequency of consultation requests for neuromuscular patients prior to surgery, 2.) current practice, educational activities and departmental approach to this topic and 3.) preoperative counselling of neuromuscular patients. Results:A total of 83 departments participated. Consultations for a neuromuscular patient scheduled for anaesthesia were requested from anaesthesia and neurology department only infrequently. Local guidelines concerning perioperative care of neuromuscular patients were available in 36.4% of the participating departments. Quality of specific training for residents and staff anaesthetists/neurologists covering perioperative care of neuromuscular patients was rated as ‘very good’ or ‘good’ by 42.9%. Neuromuscular patients scheduled for surgery were ‘always’ or ‘often’ discussed in multidisciplinary meetings involving anaesthesiologists and neurologists in 20.8% of the participating departments. Conclusion:Perioperative care for neuromuscular patients in the Netherlands is highly variable and might benefit from guidelines, education of health care professionals and multidisciplinary meetings between anaesthesiologists and neurologists on a regular basis.

Keywords: Anaesthesia, genetics, malignant hyperthermia, myopathy, perioperative care, preoperative counselling, RYR1

DOI: 10.3233/JND-221512

Journal: Journal of Neuromuscular Diseases, vol. 9, no. 6, pp. 765-775, 2022