الفهرس 
Pathophysiological Consideration of Skeletal MuscleOnly 14 pages are availabe for public view
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Abstract
The terms ’muscle disease’, ‘muscular dystrophy’, ‘neuromuscular conditions’ and ‘neuromuscular disorders’ all describe a large group of conditions which affect either the muscles, such as those in the arms and legs or heart and lungs, or the nerves which control the muscles.
There are lots of different types of muscle disease. The severity of conditions and how they affect individuals varies greatly from person to person. Most conditions are progressive, causing the muscles to gradually weaken over time. People’s mobility is affected and most conditions lead to some sort of disability.
Muscle disease affects babies, children and adults, both males and females, and all ethnic groups. Conditions can be inherited or occur out of the blue where there is no family history. These disorders are often grouped together in relation to anesthesia due to common considerations in the perioperative period. In addition to abnormal responses to muscle relaxants, these diseases may be associated with systemic problems that may profoundly affect the conduct of anesthesia.
Anesthetic management may be required either for problems relevant to the disorder or for comorbid conditions Important for anesthesia is that these disorders show various symptoms and have a high risk during general anesthesia. Especially administration of succinylcholine and volatile anesthetics may cause problems. Under special circumstances opioids, non depolarizing muscle relaxants and intravenous anesthetics can interfere with this kind of disorder, too. Complications during and after anesthesia may result in malignant hyperthermia, malignant hyperthermia-like reactions and primary or secondary changes relating to the underlying NMD These include cardiac and respiratory problems, dysautonomia as well as hypothermia or hyperthermia.
Myasthenia Gravis is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability the primary concern in anesthesia for Patient is the potential interaction between the disease, treatment of the disease, and neuromuscular blocking drugs. Myasthenia patients can receive suxamethonium, and may in fact need up to double the normal dosage. However, the sensitivity of the motor end plate to non-depolarizing agents is elevated. Volatile anesthetic agents also appear to be safe.
Myotonia are a group of hereditary intrinsic diseases of the skeletal muscles characterized by persistent contractures of skeletal muscles after voluntary contraction or following electrical stimulation resulted from genetic defects in the ion channels causing abnormal calcium metabolism abnormal responses to drugs used during anesthesia. No specific anesthetic technique has been shown to be superior for patients with myotonic dystrophy. Succinylcholine produces an exaggerated contracture and its use should be avoided to use short-acting muscle relaxants.
Muscular dystrophies are a group of progressive genetically determined degenerative myopathies. Patients suffering from muscular dystrophy have an elevated anesthetic risk, to develop malignant hyperthermia or rhabdomyolysis. In addition serious cardio-pulmonary complications are imminent during anesthesia.
Hyperkalaemic periodic paralysis require meticulous attention to avoid hypoglycaemia, which can cause hyperkalaemia and precipitate paralysis. On the contrary, hyperglycaemia, release of catecholamines, fluid infusions and mild hypothermia can all cause hypokalaemia and paralysis in Hypokalaemic Periodic Paralysis.