37yo hysterectomy + hernia repair  multidisciplinary surgery involving gynae/gen surg

Background: 

• Fibroid uterus, significant adhesions, previous failed surgery (unable to access the uterus)
• Myotonic dystrophy
  • Reflux ++, slurred speech and dysphagia
  • Normal TTE and PFTs
• Smoker

Issues:

• Large Botox dose in context of myotonic dystrophy
  • Neurologist concerned with dose and potential for systemic absorption and prolonged exacerbation of muscular issues
  • Surgeon feels the high dose botox is essential to success of the procedure

Discussion:

• Botox use in this setting
  • Injected into abdominal musculature
  • Takes 2-3 weeks for full response
  • Nil evidence/ literature around high dose botox dose in muscular dystrophy
  • Systemic absorption – risk of headaches, fever, HTN, generalized weakness, dysphagia, subsequent aspiration)

Plan:

• Await further MDT planning between neurology and surgeons
• ? reduced botox dose may be possible