Anesthesia Issues in the Perioperative Management of Myasthenia Gravis

Abstract

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction. Current anesthetic practice may require the use of neuromuscular blocking (NMB) drugs that act at this junction to facilitate control of the airway and allow procedures to be performed on a motionless MG patient. This competes with the goals of rapid emergence and recapture of preoperative muscle strength following anesthesia. In particular, avoiding prolonged periods of postoperative mechanical ventilation is a paramount concern of patients, families, and physicians. Standard anesthetic agents and, if needed, judiciously titrated NMB drugs generally allow safe emergence and immediate extubation for most low-risk MG patients. If necessary, postoperative mechanical ventilation is accomplished with the use of specialized monitoring devices that help monitor awareness and depth of sedation. Currently used intravenous sedatives allow titrated depth of sedation and rapid emergence when extubation is appropriate. Communication to the patient, family, and other caregivers of the goals of the anesthetic plan and of the patient's evolving status are also very important duties of the anesthesiologist.

Sugammadex is Safe and Effective for Patients with Myasthenia Gravis

“…This can result in a postoperative decline in respiratory function [5]. Because muscle relaxants are commonly required for intubation and surgical procedures, a muscle relaxation monitor is recommended during the perioperative period [3]. In the present cases, we used a muscle relaxation monitor perioperatively to minimize muscle relaxant use.…”

“…Currently, perioperative management involves using a muscle relaxation monitor to minimize muscle relaxant dosage. However, patients with myasthenia gravis have intrinsic muscle weakness, thus the prolonged effects of residual muscle relaxants can lead to conditions such as respiratory failure [3].…”

Successful Use of Sugammadex in a Myasthenic Patient Case Report

“…Surgery and anaesthesia in myasthenic patients are associated with an increased risk of death and severe complications [4]. So one should observe every details.…”

Neuromuscular diseases and anesthesia

“…Najčešće je prisutan timom, pa treba da se obrati pažnja na opstrukciju disajnog puta (uraditi nuklearnu magnetnu rezonanciju ili skener). Zatim su prisutni i tiroiditis (hipo ili hipertiroiditis), pa bi trebalo da se uradi TSH, FT4; sistemski lupus eritematodes, koji najčešće pokazuje simptome od strane centralnog nervnog sistema, bubrežnu insuficijenciju, hipertenziju (uraditi antinukleusna antitela, ureu, kreatinin, klirens); reumatoidni artritis, za koji je karakteristična atlantoaksijalna nestabilnost (potreban je rendgenski snimak cervikalne kičme ili skener); ankilozirajući spondilitis, usled koga je otežana pokretljivost zglobova kičmenog stuba i povećan je rizik od fraktura (uraditi rendgenski snimak kičme); kronova bolest i ulcerozni kolitis, koji dovode do češćeg postoperativnog abdominalnog bola i ileusa (uraditi skener abdomena); adrenalna supresija, koja dovodi do hipotenzije i postoperativne Adisonove krize (uraditi serumski nivo kortizola, testove adrenalne funkcije); diabetes mellitus sa komplikacijama kao što su ketoacidoza i koma (uraditii vrednosti glikoliziranog hemoglobina -HgbA1C, gasne analize); pulmonalne restriktivne i obstruktivne bolesti, koje dovode do češće produžene postoperativne mehaničke ventilacije i traheostomje (uraditi preoperativno spirometriju, radiografiju pluća, gasne analize) 8 . Sve nabrojano čini mijasteniju gravis jednom od najizazovnijih bolesti za aneteziologa.…”