Use of remifentanil and propofol without muscle relaxant combined with intrathecal morphine in children with Duchenne's muscular dystrophy undergoing spinal surgery.

Duchenne's muscular dystrophy (DMD) is the most common and severe form of myopathy occurring in pediatric patients. Sensitivity of patients with DMD to sedative, anesthetic and neuromuscular blocking agents may result in intraoperative and early postoperative cardiovascular and respiratory complications, as well as prolonged recovery from anesthesia. Anesthetic management of these patients is challenging and may cause serious problems to the anesthesiologist. We report the use of a total intravenous anesthesia technique (TIVA) with remifentanil and propofol without muscle relaxants, associated with intrathecal morphine in three children with DMD undergoing posterior spinal surgery (PSS). Tracheal intubation was successfully done with good conditions. The intraoperative course of these patients was uneventful. Controlled hypotension, rapid recovery and uneventful postoperative period were achieved with this technique. In conclusion, good conditions for tracheal intubation, controlled hypotension, rapid recovery and uneventful postoperative period can be achieved with this anesthesia technique in patients with DMD.