Myasthenia gravis in children and anaesthetic management for thymectomy

Davies, D. Wyn; Steward, David J.

doi:10.1007/bf03027163

Cited by 10 publications

(5 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Severe bradycardia is a concern in patients on AChEIs, with anesthetic techniques utilizing remifentanil,[16] high thoracic epidural local anesthetics,[17] or spinal anesthesia,[18] particularly with vagal stimulation occurring during intubation. As reported by others,[3] one of our patients developed severe but self-limited sinus bradycardia during intubation. For subsequent cases, we administered an anticholinergic agent preemptively.…”

Section: Discussionsupporting

confidence: 80%

“…Older reports indicated increased postoperative complications with perioperative AChEI administration and recommended avoiding them preoperatively. [3] However, advising patients to withhold their preoperative dose may result in increased muscle weakness. In contrast, patients who continue to take their pyridostigmine may have increased secretions or develop a cholinergic crisis with muscarinic symptoms (nausea, sweating, miosis, and bradycardia).…”

Section: Discussionmentioning

confidence: 99%

“…[1] Although the adult and juvenile forms of MG share a similar pathophysiology and clinical presentation, the epidemiology, prognosis, and some aspects of treatment are different for JMG. [2] Apart from an older series,[3] most reports on the current anesthetic management in children are case reports. [4] We present a case series of the perioperative management of patients with JMG undergoing transsternal thymectomy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

et al. 2011

View full text Add to dashboard Cite

Background:Juvenile myasthenia gravis (JMG) is the rare form of myasthenia gravis presenting in childhood and adolescence. When medical management fails, thymectomy is offered for these patients. Complete resection of the thymus is best achieved through transsternal thymectomy. Anesthetic management of patients with JMG is challenging, particularly in regards to the goals of postoperative pain control, respiratory function, and extubation.Methods:We retrospectively reviewed the medical records of 13 patients, ranging in age from 6 to 22 years, who underwent transsternal thymectomy for JMG. Information on patient demographics, characteristics of their disease and treatment, anesthetic management, and postoperative course were collected.Results:All patients had undergone multiple treatment modalities and presented for surgery because of inadequate symptom control with medical management. As expected for a pediatric population, anesthesia induction was age dependent. 40% of the patients underwent an inhalation induction and 60% underwent an intravenous induction. Anesthesia was maintained with a low-dose inhalation agent in all patients, supplemented in 84% of patients with a remifentanil infusion, and in 69% of patients with an epidural infusion. Muscle relaxants were avoided in all patients. With this regimen, 92% of patients could be extubated successfully in the operating room.Conclusion:We found that avoidance of muscle relaxants and use of remifentanil with a low-dose hypnotic agent provided a stable intraoperative course, facilitated rapid emergence, and allowed early extubation in patients with JMG undergoing transsternal thymectomy. Epidural analgesia reduced the need for intra- and postoperative intravenous opioids and did not have an adverse effect on respiratory strength.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

et al. 2011

View full text Add to dashboard Cite

show abstract

“…An affected infant displays muscle weakness and an increased sensitivity to nondepolarizing neuromuscular blocking drugs. 1 These symptoms improve with maturation of the infant's immune system, a feature which distinguishes transient neonatal myasthenia from other forms of congenital myasthenia gravis. 2 We report the anaesthetic management of an at risk neonate who presented for urgent repair of bladder exstrophy in the first 2 days of life.…”

mentioning

confidence: 99%

Bladder exstrophy in a neonate at risk of transient myasthenia gravis: a role for remifentanil and epidural analgesia

Wee¹,

Stokes²

1999

British Journal of Anaesthesia

View full text Add to dashboard Cite

Infants born to mothers with myasthenia gravis may exhibit a transient form of the disease, with similar sensitivity to non-depolarizing neuromuscular blocking drugs. We report the case of an infant at risk who required major surgery when 48 h old for closure of bladder exstrophy. A combined epidural-general anaesthetic technique, with remifentanil supplementation, enabled us to avoid unnecessary neuromuscular blocking drugs and prolonged intensive care, which had been anticipated. The potential benefits of remifentanil and epidural analgesia in neonates are discussed.

show abstract

“…Anesthetists have a special interest in myasthenia gravis because of its interaction with various anesthetic agents and because many myasthenics require a thymectomy to control their disease. Much has been written about the critical care management and anesthesia for adult myasthenic patients (1–6), but there is very little relating to modern pediatric anesthetic practice (7,8). In 1990, Brown et al .…”

Section: Introductionmentioning

confidence: 99%