Table 2.

Possible complications with different groups of drugs

Group of agents	Agents	Mode of administration/mode of action	Possible side effects	Recommendations about use of agent in neuromuscular disorders
Volatile anaesthetics	Halothane Enflurane Isoflurane Sevoflurane Desflurane	Inhalation Anaesthesia	Malignant hyperthermia reaction Hypotension and arrhythmia Airway obstruction	Contraindicated in malignant hyperthermia–susceptible people
Depolarising muscle relaxants	Succinylcholine	Intravenous Very rapid and short-lasting muscle relaxation (<1 min) ‘Rapid sequence induction’ in case patients are not sober	Bradycardia (as prevention the 2nd dose has to be combined with atropine) Hyperkalaemia Myalgia Rhabdomyolysis Malignant hyperthermia reaction	Contraindicated in all neuromuscular disorders Contraindicated in malignant hyperthermia–susceptible individuals
Non-depolarising muscle relaxants	Rocuronium Mivacurium Atracurium Vecuronium Pancuronium	Intravenous Middle-lasting muscle relaxation Measure the effect during surgery Antagonise at the end of the procedure (with specific antagonists or cholinesterase inhibitors)	Allergic response	Caution with all neuromuscular disorders: Reduce the dose In case of muscular dystrophies, do not antagonise with cholinesterase inhibitors
Benzodiazepines	Midazolam Diazepam	Intravenous, oral of rectal Anaesthesia, sedation, anxiolytic	Skin rash Respiratory suppression Airway obstruction (Sedation)	Caution with all neuromuscular disorders: Reduce the dose Monitor respiratory function
Morphine and other opioids/morphine derivates	Morphine Fentanyl Remifentanil Sufentanil	Oral, rectal, transdermal, subcutaneous, intramuscular, intravenous, spinal and epidural Analgesia	Miosis Sedation Nausea and vomiting Respiratory suppression	Caution with all neuromuscular disorders: Reduce the dose Use a short-acting agent

A summary of the effects, adverse effects and recommendations of the most frequently used anaesthetic agents in people with neuromuscular disorders.