Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy

Datt, Vishnu; Tempe, Deepak K; Tomar, Akanksha; Banerjee, Amit; Dutta, Devesh; Bhandari, Hricha

doi:10.4103/0971-9784.58835

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…However, the safe dose of muscle relaxant varies with each patient and hence its use in a case of MG remains controversial. Peri-operative use of benzodiazepines may also cause myasthenic crisis [3] and hence should be cautiously used.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management in a known case of myasthenia gravis posted for sternotomy with thymectomy

Gala¹,

Jain²,

Chinchkar³

et al. 2021

Int. J. Med. Anesthesiology

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Myasthenia gravis (MG) is a chronic disorder of the neuromuscular junction. It is characterized by circulating antibodies against the acetylcholine receptors resulting in a decrease in the functional acetylcholine receptors at the neuromuscular junction. Hence the anaesthetic management is challenging in these cases due to unpredictable susceptibility of acetylcholine receptors to muscle relaxants. In this case report, we are describing the successful anaesthetic management of a patient with myasthenia gravis undergoing sternotomy with thymectomy for a swelling on left side of the neck. We concluded that it is possible to provide anaesthesia and pain relief without the use of skeletal muscle relaxants during general anaesthesia and without the need of prolonged postoperative ventilation in a patient of MG.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic management in a known case of myasthenia gravis posted for sternotomy with thymectomy

Gala¹,

Jain²,

Chinchkar³

et al. 2021

Int. J. Med. Anesthesiology

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“…Also, the association of MG with other autoimmune disorders such as thyrotoxicosis, hypothyroidism, hypokalemic periodic paralysis, rheumatoid arthritis, sjogren's syndrome, systemic lupus erythmatosis and diabetes mellitus is well known. 2 Preoperative evaluation of the patient with MG includes review of the severity of the patient's disease and the treatment regimen. Specific attention should be paid to voluntary and respiratory muscle strength.…”

Section: Discussionmentioning

confidence: 99%

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

Lal

Bansal

2016

Cumhuriyet Med J

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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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“…Whether thymectomy during a myasthenic crisis may jeopardize the patient, or may prolong hospitalization and should only be carried out after pre-operative stabilization is under debate. However, there are indications that thymectomy can be safely performed even in patients with uncontrolled MG if there is proper pre-operative preparation, good anesthetic management, and optimal peri-operative respiratory care [16]. …”

Section: Discussionmentioning

confidence: 99%

Successful low-dose azathioprine for myasthenia gravis despite hepatopathy from primary sclerosing cholangitis: a case report

Finsterer

Höflich

2010

J Med Case Reports

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IntroductionAlthough myasthenia gravis is frequently associated with other disorders, it has not been reported together with primary sclerosing cholangitis, complicating the administration of liver-toxic immunosuppressive therapy.Case presentationA 73-year-old Caucasian woman with a history of arterial hypertension, thyroid dysfunction, glaucoma, right-sided ptosis and later generalized weakness, was diagnosed with myasthenia gravis. Additionally, primary sclerosing cholangitis was detected, initially prohibiting the administration of immunosuppressants. Despite treatment with steroids and pyridostigmine she repeatedly experienced myasthenic crises. After the fifth crisis and after antibody titers had reached levels > 100 nmol/L during two years of follow-up, it was decided to restart azathioprine. Interestingly, low-dose azathioprine (1.5 mg/kg/day) was well tolerated, had a positive clinical and immunological effect and did not worsen primary sclerosing cholangitis.ConclusionMyasthenia gravis may occur together with primary sclerosing cholangitis in the same patient. Mild immunosuppression with azathioprine is feasible and effective in such a patient, without worsening myasthenia gravis or primary sclerosing cholangitis.

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Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy

Cited by 7 publications

References 18 publications

Anaesthetic management in a known case of myasthenia gravis posted for sternotomy with thymectomy

Anaesthetic management in a known case of myasthenia gravis posted for sternotomy with thymectomy

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

Successful low-dose azathioprine for myasthenia gravis despite hepatopathy from primary sclerosing cholangitis: a case report

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