A small compilation of nurse anesthesia care plans

These anesthesia care plans are meant to inspire nurse anesthesia residents when they are making their care plans. Always make sure you fully understand and "own" your care plan. Your plan must be specific for your patient and should always be with the most up-to-date information.

Myotonic Dystrophy Treatment

A group of hereditary degenerative muscle diseases, where Myotonic Dystrophy is adulthood's most common and severe inherited muscular dystrophy

The key is the muscle's inability to relax after chemical or physical stimulation – myotonia worsened by pressure, touch, cold, or shivering

Skeletal muscles are hypoplastic (underdeveloped), dystrophic (muscles weaken and atrophy), and weak yet prone to persistent contraction

Onset at any age, but usually second or third decade of life - slow, progressive deterioration of skeletal, cardiac, and smooth muscle with death usually by the 6th decade

Etiology

Disorder of muscle membrane excitability resulting in self-sustaining runs of depolarization (contractions)

Treatment for contractions

Na+ channel blockers - Quinidine, Procainamide, and phenytoin, which will delay the return of membrane excitation

Warming or injection of local anesthetics into involved muscles may induce relaxation

Steroids and inhalational agents may attenuate the contraction in some patients

Clinical manifestations

Facial weakness, ptosis, sternocleidomastoid muscle, and distal limb weakness are prominent

Diabetes and thyroid disease may be seen

Cardiac

  • 1st-degree AV block is the most common
  • Arrhythmias such as sinus bradycardia, atrial flutter or fibrillation, or PVCs

Pulmonary

  • Weak thoracic muscles and weak diaphragm = decreased FRC, VC, and restrictive pattern
  • Decreased response to hypercarbia

Anesthetic considerations

Preparation for MH risk patient

  • Change breathing circuits, inactivate vaporizers, flush with O2 or air at 10 L/min for at least 20 min
  • Monitor ETCO2 closely - first sign of MH along with O2 sat and core temperature (nose/esophageal)
  • Avoid Succinylcholine - it can produce intense generalized Myotonic contracture, which impairs ventilation and intubation markedly
  • Avoid Malignant Hypertension provoking drugs - inhalational agents (DES/SEVO/ISO) and succinylcholine
  • IF MH, administer dantrolene 2.5 mg/kg up to 10 mg/kg
    • 20 mg/vial (Dantrium, Revonto), reconstitute with 60 mL sterile water
      • Shake the vial for about 20 seconds or until the solution is clear
    • 250 mg/vial (Ryanodex), reconstitute with 5 mL of sterile water
      • Shake the vial to ensure an orange-colored uniform suspension
      • Visually inspect the vial for particulate matter and discoloration before administration 
    • Therapeutic or emergency doses can be administered with rapid IV push
      • Follow-up doses should be administered over 2-3 min
  • Decreased FRC and VC
  • Risk of pulmonary aspiration due to weak respiratory muscles and hypomotility of the bowel
  • Avoid hypothermia and shivering
  • Risk of prolonged effect of anesthetic
  • Propofol, nitrous oxide, benzodiazepines ok