MİYASTENİA GRAVİS VE ANESTEZİ YÖNETİMİ

Miyastenia Gravis (MG) nöromusküler kavflağı tutan ve çizgili kaslarda güçsüzlüğe neden olan bir kas hastalığı türüdür. Toplumda nadir görülse de bu hastalığın ortaya çıkardığı patofizyolojik değiflimlerin kas gevfleticiler ve pek çok ilaç ile yakın iliflkili olması gibi nedenlerle MG anestezistlerin gündeminden düflmeyen özel bir durumdur. Stresle de tetiklenebilen bu hastalığın postoperati f solunum yetmezliği gelifltirme riski bulunması nedeniyle mekanizmasının ve yönetiminin tüm anestezi uygulayıcıları tarafından ayrıntılı olarak bilinmesi gerekmektedir. Bu derlemede MG hastalığının yönetiminde anestezik yaklaflımlara ıflık tutmak ve farkındalığın arttırılması amaçlanmıfltır.

MYASTENIA GRAVIS AND ANESTHESIA MANAGEMENT

Myasthenia Gravis (MG) is a muscle disease affecting the neuromuscular junction and characterised by weakness of skeletal muscle. Although, MG is rarely in society, it is a special research area for the clinicians and one of the important headings which anesthesiologists interested in. Nowadays the disease still have a challenge in the anesthesiology community because the pathophysiological consequences of the disease are closely associated with to many drugs like muscle relaxants. The mechanism and the management of the disease which is also triggered by stress factors, should have particularly known by all the anesthesiologists, because of the risk of postoperative respiratory failure. In this review, we aimed to increase awareness of the clinicians about the anesthetic approach to the management of MG disease

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  • 1. Berrih-Aknin S, Frenkian-Cuvelier M, Eymard B. Diagnostic and clinical classification of autoimmune myastenia gravis. J Autoimmun 2014; 48-49: 143-148.
  • 2. Gilhus NE. Myastenia and the neuromuscular junction. Curr Opin Neurol 2012; 25: 523-529.
  • 3. Gonseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myastenia gravis. Neurology 2000; 55: 7-15.
  • 4. Carr AS, Cardwell CR, McCarron PO, McConville J. A systemic review of population based epidemiological studies in myastenia gravis. BMC Neurol 2010; 10: 10-46.
  • 5. Huang X, Liu WB, Men LN, et al. Clinical features of myastenia gravis in southern China: a retrospective review of 2,154 cases over 22 years. Neurol Sci 2013; 34: 911-917.
  • 6. Murai H, Yamashita N, Watanabe M et al. Chacteristics of myastenia gravis according to onset age: Japanese nationwide surve. J Neurol Sci 2011; 305: 97-102.
  • 7. McGrogan A, Sneddon S, de Vries CS. The incidence of myastenia gravis: a systematic literature review. Neuroepidemiology 2010; 34: 171-183.
  • 8. Lindstorm J. Acetylcholine receptors and myastenia. Muscle Nerve 2000; 23: 453-477.
  • 9. Misgeld T, Kummer TT, Lichtman JW, Sanes JR. Agrin promotes synaptic differentiation by counteracting an inhibitory effect of neurotransmitter. Proc Natl Acad Sci USA 2005; 102: 11088-11093.
  • 10. Motomura M, Narita Masuda T. Autoantibodies in myasthenia gravis. Brain Nerve 2013; 65: 433-439.
  • 11. Gold R, Hohfeld R, Toyka KV. Progress in the treatment of myastenia gravis. Ther Adv Neurol Disord 2008; 1: 36-51.
  • 12. Pasnoor M, Wolfe GI, Nations S, et al. Clinical findings in MuSK-antibody positive myastenia gravis: a U.S. experience. Muscle Nerve 2010; 41: 370-374.
  • 13. Pascuzzi RM, Coslett HB, Johns TR. Long-term corticosteroid treatment of myasthenia gravis: Report of 116 cases. Ann Neurol 1984; 15: 291-298.
  • 14. Silvestri NJ, Wolfe GI. Treatment-refractory myasthenia gravis. J Clin Neuromuscul Dis 2014; 15: 167-178.
  • 15. Yamada Y, Yoshida S, Suzuki H, et al. Efficacy of perioperative high-dose prednisolone therapy during thymectomy in myastenia gravis patients. J Cardiothorac Surg 2013; 8: 226.
  • 16. Sorgun MH, Sener HO, Yucesan C, Yucemen N. Intravenous immunoglobulin for prophylaxis of acute exacerbation in Myastenia Gravis. Neurol Sci 2014; 35: 891-896.
  • 17. Heatwole C, Johnson N, Holloway R, Noyes K. Plasma exchange versus intravenous immunoglobulin for myastenia gravis crisis: an acute hospital cost comparison study. J Clin Neuromuscul Dis 2011; 13: 85-94.
  • 18. Diaz A, Black E, Dunning J. Is thymectomy in non-thymomatous myastenia gravis of any benefit? Interact Cardiovasc Thorac Surg 2014; 18: 381-389.
  • 19. Grant RP, Jenkins LC. Prediction of the need for postoperative mechanical ventilation in myasthenia gravis: thymectomy compared to other surgical procedures. Can Anaesth Soc J 1982; 29: 112-116.
  • 20. Baraka A. Anaesthesia and myasthenia gravis. Can J Anaesth 1992; 39(5); 476-486.
  • 21. Romero A, Joshi GP. Neuromuscular Disease and Anesthesia Muscle Nerve 2013; 48; 451-460.
  • 22. Hirsch NP. Neuromuscular junction in health and disease. Br J Anaesth 2007; 99: 132-138.
  • 23. White MC, Stoddart PA. Anesthesia for thymectomy in children with myasthenia gravis. Pediatric Anesthesia 2004; 14: 625-635.
  • 24. Almeida C, Coutinho E, Moreira D, Santos E, Aguiar J. Myasthenia gravis and pregnancy: anaesthetic management a series of cases. Eur J Anaesthesiol 2010; 27: 985-990.
  • 25. Unterbuchner C, Fink H, Blobner M. The use of sugammadex in a patient with myasthenia gravis. Anaesthesia 2010; 65: 302-305.
  • 26. Blichfeldt-Lauridsen L, Hansen BD. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand 2012; 56: 17-22.
Anestezi Dergisi-Cover
  • ISSN: 1300-0578
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1993
  • Yayıncı: Betül Kartal