Author: AlAamer R et al.
Cureus 17(10), October 2025. DOI: 10.7759/cureus.95759
This case report and literature review describe the successful use of a trigger-free neuraxial anesthetic technique in a 31-year-old woman with limb-girdle muscular dystrophy (LGMD) who required emergency evacuation of retained products of conception (ERPC) four days after a miscarriage. Because LGMD carries a risk of anesthesia-related rhabdomyolysis, hyperkalemia, and unpredictable responses to neuromuscular blockers, the anesthetic plan emphasized complete avoidance of volatile agents and succinylcholine. A vapour-free workstation was prepared, dantrolene availability verified, and a total intravenous anesthesia (TIVA) backup plan established.
Single-shot spinal anesthesia with 10 mg of 0.5% hyperbaric bupivacaine at the L3–L4 level achieved an appropriate sensory level for surgery. The procedure lasted about 20 minutes with stable hemodynamics, no sedatives or muscle relaxants used, and no signs of rhabdomyolysis or hypermetabolic reaction. Postoperative recovery was uneventful, and the patient was discharged the same day. Follow-up confirmed full recovery without complications.
The authors reviewed published cases showing that neuraxial techniques—including spinal, epidural, and combined spinal–epidural anesthesia—can be safely performed in LGMD patients for obstetric and gynecologic procedures when accompanied by trigger-free precautions. Regional anesthesia offers the advantage of avoiding agents that may precipitate rhabdomyolysis or hyperkalemia and allows rapid recovery in suitable patients. For those in whom regional techniques are contraindicated or fail, propofol-based TIVA without neuromuscular blockade remains the preferred alternative.
What You Should Know
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LGMD patients are at risk for anesthesia-induced rhabdomyolysis and hyperkalemia, especially with volatile anesthetics and depolarizing muscle relaxants.
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A rigorously “trigger-free” pathway—including vapour-free machine setup, temperature and capnography monitoring, and postoperative electrolyte and creatine kinase checks—enhances safety.
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Neuraxial anesthesia should be considered first-line for short gynecologic procedures when feasible, with TIVA reserved for contraindications or failed blocks.
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Careful preparation, interdisciplinary coordination, and vigilant postoperative surveillance are essential for safe anesthetic management in muscular dystrophy patients.
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