Mehrican ŞAHİN, Mehmet CESUR, Ayşe MIZRAK, Vahap SARIÇİÇEK, Çiğdem KADI

Antagonism of the Effect of Rocuronium with Sugammadex in a Patient with Myasthenia Gravis

Myastenia Gravis (MG), kas sinir kavşağında asetilkolin reseptörlerin sayı ve fonksiyon kapasitesinin azalması ile karakterize otoimmun bir hastalıktır. Myastenia gravisli hastaların kas gevşetici kullanılması gereken durumlarda artmış postoperatif residüel nöromusküler blokaj riski nedeniyle anestezisi önem arz etmektedir. Sugammadeksin keşfinden önce non depolarizan kas gevşeticilerin etkisini geri döndürmede kullanılan kolinesteraz inhibitörleri spesifik bir antagonist olmadığı gibi aynı zamanda MG hastaların tedavisinde de kullanılmaktadır. Bu durum MG'li hastalarda istenmeyen etkilere yol açabilmektedir. Sugammadeks steroid yapılı kas gevşeticileri enkapsule ederek etkilerini hızlı bir şekilde ortadan kaldırır. Bu özelliğinden dolayı MG'li hastalarda postoperatif rezidüel blok ve mekanik ventilasyon gereksinimini azaltmak amacıyla anestezistler tarafından kullanılmaya başlanmıştır. Bu olgu sunumunda, VATS yapılan bir hastada rokuronyumun etkisinin sugammadeksle antagonize edilmesi ile ilgili deneyimimizi paylaşmayı amaçladık.

Myastenia Gravisli Hastada Rokuronyum Etkisinin Sugammadeks ile Antagonize Edilmesi

Myasthenia Gravis (MG) is an autoimmune disorder which is characterized by the decrease of number, function, and capacity of ach receptors in muscle-nerve junctions. Anaesthesia is important patients with MG especially when they need muscle relaxants, which is a risky condition due to the possibility of postoperative residual neuromuscular blockage. Before the discovery of Sugammadex, colinesterase inhibitors were used to reverse the effects of non-depolarising muscle relaxants to treat MG patients. In these cases, practitioners had to deal with several side effects in MG patients. Sugammadex encapsules the steroid structured muscle relaxants and immediately reverses their effects. Therefore, anaesthesiologists started to use Sugammadex to decrease the need of postoperative residual blockage and mechanical ventilation. In this case report, we aim to share our experiences of Sugammadex use and relate readers how it eliminated the effect of rocuronium in an MG patient who underwent VATS.

PDF

___

Blichfeldt-Lauridsen L, Hansen BD. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand. 2012;56:17-22
Sungur Ulke Z, Yavru A, Camci E, Ozkan B, Toker A, Senturk M Rocuronium and sugammadex in patients with myasthenia gravis undergoing thymectomy. Acta Anaesthesiol Scand. 2013;57:745-8
Saricicek V, Sahin L, Bulbul F, Ucar S, Sahin M, Does Rocuronium-Sugammadex Reduce Myalgia and Headache After Electroconvulsive Therapy in Patients With Major Depression? J ECT. 2014;30(1):30-4.
Sungur Ulke Z, Senturk M. Mivacurium in patients with myasthenia gravis undergoing video-assisted thoracoscopic thymectomy. Br J Anesth 2009; 103: 310-1.
Paterson IG, Hood JR, Russel SH, Weston MD, Hirsch NP. Mivacurium in the myasthenic patient. Br JAnaesth 1994;73:494-8.
Mekis D, Kamenik M. Remifentanil and high thoracic epidural anaesthesia: a successful combination for patients with myasthenia gravis undergoing transsternal thymectomy. Eur J Anaesthesiol 2005;22:392-9.
Gritti P, Carrara B, Khotcholava M, Bortolotti G, Giardini D, Lanterna LA, et al. The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video-assisted thoracoscopic extended thymectomy. Acta Anaesthesiol Scand. 2009;53:380-9.
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.
Unterbuchner C, Fink H, Blobner M. The use of sugammadex in a patient with myasthenia gravis. Anaesthesia. 2010;65:302-5.
Argiriadou H, Anastasiadis K, Thomaidou E, Vasilakos D. Reversal of neuromuscular blockade with sugammadex in an obese myasthenic patient undergoing thymectomy. J Anesth. 2011;25:316-7.
Karaman Y, Çakmak M, özkarakaş H, Güvenli Y, Gönüllü M. Myastenia gravisli hastada sugammadeks ile postoperatif mekanik ventilasyon gereksinimi azalı mı? Ege Tıp Dergisi/ Ege Journal of Medicine. 2012;251(1): 69-71.