| Consider use of a total intravenous anesthesia technique for induction and maintenance of general anesthesia (eg, propofol and short-acting opioids) |
| • The use of depolarizing muscle relaxants such as succinylcholine is absolutely contraindicated because of the risk of fatal reactions |
| Optimize the medical setting and personnel in attendance when patients with DMD undergo general anesthesia or procedural sedation, and have an intensive care unit available for postprocedure care |
| Options for providing respiratory support during maintenance of general anesthesia or procedural sedation for patients with DMD include: |
| • Endotracheal intubation, with use of noninvasive positive pressure ventilation (NPPV) to facilitate extubation for selected patients |
| • Laryngeal mask airway |
| • Manual or mechanical ventilation (using conventional ventilators or bilevel positive pressure ventilators designed for noninvasive respiratory support) delivered via a full face mask or nasal mask interface |
| Application of ventilation in the assisted or controlled modes should be considered for patients with DMD and a forced vital capacity (FVC) <50 percent of predicted, and strongly considered for those with an FVC <30 percent of predicted, during induction of and recovery from general anesthesia and throughout procedural sedation |
| • Options for respiratory support during induction of and recovery from general anesthesia or procedural sedation include manual ventilation using a flow-inflated manual resuscitation bag (standard "anesthesia bag") with a full face or nasal mask interface, and mechanical support using a conventional or noninvasive positive pressure ventilator via a full face or nasal mask |
| Intraoperatively, continuously monitor oxyhemoglobin saturation measured by pulse oximetry and, whenever possible, blood or end-tidal carbon dioxide levels |
