Open AccessPectoralis blocks for insertion of an implantable cardioverter defibrillator in two patients with Duchenne muscular dystrophy
Author(s) -
Alexander B. Froyshteter,
Tarun Bhalla,
Joseph D. Tobias,
Gregory S Cambier,
Christopher McKee
Publication year - 2018
Publication title -
saudi journal of anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.416
H-Index - 24
eISSN - 1658-354X
pISSN - 0975-3125
DOI - 10.4103/sja.sja_624_17
Subject(s) - medicine , duchenne muscular dystrophy , implantable cardioverter defibrillator , anesthetic , cardiomyopathy , sedation , perioperative , anesthesia , cardiology , surgery , heart failure
Patients with Duchenne muscular dystrophy (DMD) often have systemic manifestations with comorbid involvement of the cardiac and respiratory systems that increase the risk of anesthetic and perioperative morbidity. These patients frequently develop progressive myocardial involvement with cardiomyopathy, depressed cardiac function, and arrhythmias. The latter may necessitate the placement of an automatic implantable cardioverter defibrillator (AICD) insertion. As a means of avoiding the need for general anesthesia and its inherent potential of morbidity, regional anesthesia may be used in specific cases. We present two cases of successful AICD insertion in patients with DMD using unilateral pectoralis and intercostal nerve blocks supplemented with intravenous sedation. Relevant anatomy for this regional anesthetic technique is reviewed and benefits of this anesthetic technique compared to general anesthesia are discussed.