Myasthenia gravis: Anaesthetic implications and considerations-a report of two cases

Myastenya gravis iskelet kaslarında, dinlenmeyle düzelen zayıflık ve yorgunlukla karakterize otoimmün bir hastalıktır. Böyle bir hastanın perioperatif yönetiminde anesteziyolojistin önemli bir etkisi vardır. Çünkü hastalık nöromuskuler kavşağı etkilemektedir. Aynı zamanda myastenia gravisin diğer otoimmün hastalıklar birlikteliği iyi bilinmektedir. Hastanın preoperatif değerlendirmesi hastalığının şiddetinin gözden geçirilmesi ve tedavi rejimini kapsar. Myasteniya hastasının durumunun optimizasyonu cerrahi riskini anlamlı derecede azaltır ve sonuçlarını iyileştirir. Anestezi uygulaması, anestezik ajanın minimal uygulama dozuyla yapılmalıdır. Süksinil koline karşı öngörülemeyen yanıt ve nondepolarizan kas gevşeticilerine belirgin hassasiyet olabileceği için, kas gevşeticilerden sakınılmalıdır. Tüm hastalar postanestezi ünitesinde ya da cerrahi yoğun bakımda respiratuar desteği hemen sağlayabilecek şekilde yakından monitörüze edilmelidir

Myastenya gravis: Anestezik müdahaleler ve görüşler-iki olgu sunumu

Myasthenia gravis is an autoimmune disease characterized by weakness and fatigueability of skeletal muscles with improvement following rest. Perioperative management of such a patient poses a significant challenge to the anaesthesiologist, because it affects the neuromuscular junction. Also, the association of myasthenia gravis with other autoimmune disorders is well known. Preoperative evaluation of the patient includes review of the severity of the patient's disease and the treatment regimen. Optimisation of the condition of the myasthenic patient can markedly decrease the risk of surgery and improve the outcome. Anaesthetic management must be accomplished with the minimal applicable dose of the anaesthetic agents. Because of the unpredictable response to succinylcholine and the marked sensitivity to non depolarizing muscle relaxants, muscle relaxants should be avoided. All patients should be closely monitored postoperatively in the post anaesthesia care unit or surgical intensive care unit, where respiratory support can be immediately reinstituted

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Abel M, Eisenkraft JB. Anesthetic
implications of myasthenia gravis. The
mountsinai journal of medicine 2002; 69: 31-7.
Datt V, Tempe DK, Singh B, Tomar AS, Banerjee A, Dutta D, et al. Anesthetic management of patient with myasthenia gravis
hyperthyroidism for thymectomy. Ann Card Anaesth 2010; 13: 49-52.
Naguib M, El- dawlatly AA, Ashour M, EA. of determinants
postoperative ventilation in myasthenia gravis. Can J Anaesth 1996; 43: 1006- 13. Multivariate need the
for 4. Leventhal SR, Orkin FK, Hirsh RA. Prediction of the need for postoperative mechanical ventilation in myasthenia gravis. Anesthesiology 1980; 53: 26-30. 5. Baraka A, Taha S, Yazbeck V, Rizkallah P. myasthenicpatient.
anticholinesterase therapy. Anaesthesia 1993; 48: 588-90. in the of Influence
Eisenkraft JB, Book WJ, Mann SM, Papatestas AE, Hubbard M. Resistance to succinylcholine in myasthenia gravis: A dose- response study. Anesthesiology 1988; 69: 760-3.
Baraka A. Suxamethonium block in the myasthenic patient. Correlation with plasma 1992; 47: 217-9.
Anaesthesia 8. Kim JH, Mangold J. Sensitivity to both vecuronium and neostigmine in a sero- negative myasthenic patient. Br J Anaesth 1989; 63: 497-500.
Dubey SR, Shah NP, Patel HJ, Swadia VN, Agrawal D, Gandhi A. Anaesthetic management
myasthenia gravis in a known case of hyperthyroidism and bronchial asthma posted for thymectomy- a case report. Indian J Anaesth 2004; 48: 59-61.
with 10.Kiran U, Choudhury M, Saxena N, Kapoor P. Sevoflurane as a sole anaesthetic agent for thymectomy in myasthenia gravis. Acta Anaesthesiol Scand 2000; 44: 351-3.
Bansal T, Hooda S. Newer drugs in anaesthesia. Int J Pharm PharmSci 2012; 4: 668-70.