Neuromuscular disorders (ALS, muscular dystrophy)

Neuromuscular disorders (NMDs) are distinct diseases that share reduced respiratory-muscle strength, impaired cough/airway protection and heightened sensitivity to sedatives/anaesthetic drugs — but their specific anaesthetic hazards differ, so manage them individually. • ALS (amyotrophic lateral sclerosis, a motor-neuron disease): progressive respiratory + bulbar weakness; depolarising blockers (succinylcholine) contraindicated — hyperkalaemia from denervation-related ACh-receptor up-regulation; marked sensitivity to respiratory depressants and to non-depolarising NMBAs. • Duchenne/Becker muscular dystrophy (dystrophinopathies): succinylcholine and volatile inhalational agents avoided (rhabdomyolysis + hyperkalaemia); TIVA if GA is needed; progressive dilated cardiomyopathy is common. • Myotonic dystrophy (DM1/DM2): extreme sensitivity to sedatives/opioids (prolonged apnoea even at normal doses); succinylcholine can trigger myotonic contracture/masseter spasm; cardiac conduction defects/arrhythmias carry a sudden-death risk; aspiration from pharyngeal weakness and gastroparesis. Dental bottom line for all: prefer local anaesthesia, avoid/limit sedation and opioids, use aspiration precautions, and confirm cardiac status before sedation/GA in dystrophinopathy or myotonic dystrophy.