Lambert-Eaton myasthenic syndrome during anesthesia: a report of 37 patients

Weingarten, Toby N.; Araka, Cadmar N.; Mogensen, Matthew E.; Sorenson, Joseph P.; Marienau, Mary E. Shirk; Watson, James C.; Šprung, Juraj

doi:10.1016/j.jclinane.2014.09.009

Cited by 20 publications

(17 citation statements)

References 13 publications

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“…Other studies were on the anesthetic management of patients with myotonic dystrophy type I (DMI) 29 , 30 and II, 31 , 32 amyotrophic lateral sclerosis, 33 – 35 Duchenne muscular dystrophy, 36 glycogen storage disease, 37 inclusion body myositis, 38 Lambert–Eaton myasthenic syndrome, 39 mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes mitochondrial encephalomyopathy 40 and OPMD. 41 Opioid use was possibly associated with postoperative complications in a small retrospective study on the anesthetic management of DMI.…”

Section: Resultsmentioning

confidence: 99%

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Bersselaar

Gubbels

Riazi

et al. 2022

Can J Anesth/J Can Anesth

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Purpose Patients with neuromuscular disorders (NMDs) are at increased risk of perioperative complications. The objective of this scoping review was to examine emerging evidence from published studies, case reports, and review articles on anesthetic management of patients with NMDs, following the methodological frame for scoping reviews. Sources We searched PubMed and EMBASE for articles published between 1 January 2000 and 14 July 2021. Principal findings Three prospective and 21 retrospective studies on altered pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBA) in NMD patients were included. Furthermore, 168 case reports/series reporting 212 anesthetics in 197 patients were included. These studies showed that preanesthetic neuromuscular monitoring can be used for precise NMBA dosing in myasthenia gravis patients. Sugammadex was associated with fewer postoperative myasthenic crises. Perioperative complications were not associated with specific anesthetic agents. Case reports/series showed that in 32% (67/212) of anesthetics, at least one complication was reported. Unexpected intensive care unit admission was a frequently reported complication. Patients with a complicated disease course may have had a higher use of succinylcholine (unadjusted relative risk, 0.13; 95% confidence interval [CI], 0.20 to 0.86) and volatile anesthetics (adjusted odds ratio [OR], 0.38; 95% CI, 0.20 to 0.73; P = 0.004). Conclusion Evidence on the anesthetic management and perioperative complications of patients with NMDs is mainly based on small retrospective studies and case reports. Further clinical trials or large retrospective studies are required to investigate the choice of safe anesthetic agents. Main areas of interest are the potential benefits of neuromuscular monitoring and sugammadex and the risks possibly associated with volatile anesthetics and succinylcholine. Supplementary Information The online version of this article contains supplementary material available 10.1007/s12630-022-02230-3.

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Section: Resultsmentioning

confidence: 99%

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Bersselaar

Gubbels

Riazi

et al. 2022

Can J Anesth/J Can Anesth

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“…This variable response is seen in patients with known LEMS, and in a retrospective review of 37 surgical patients with known LEMS undergoing 60 operations, 4 patients had respiratory complications following administration of muscle relaxants [8].…”

Section: Discussionmentioning

confidence: 99%

Lambert Eaton Myasthenic Syndrome diagnosed following prolonged neuromuscular blockade: beware the patient with weak legs

et al. 2016

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We present the case of a patient who had a tonsillar biopsy as a day case and developed prolonged neuromuscular blockade. He was diagnosed with Lambert Eaton Myasthenic Syndrome (LEMS) and a subsequent biopsy confirmed mixed small and non-small cell lung cancer.This case reinforces the importance of neuromuscular monitoring and investigating episodes of prolonged neuromuscular blockade. It also highlights the significance of patients who complain of lower limb weakness during their anaesthetic pre-assessment and the requirement for further evaluation.

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“…14 In 37 patients undergoing 60 operative procedures with diagnosed or unrecognized (3 of 37) LEMS at tertiary referral center, an increased sensitivity of neuromuscular blockade with an 11% rate of pulmonary complications was noted. 15 Since symptoms respond to treatment with 3,4-diaminopyridine and intravenous immunoglobulin (IV IG), preoperative diagnosis and adequate symptom relief on medication are important to reduce postoperative complications.…”

Section: Evaluation Of the Patient At Increased Risk Of Perioperativementioning

confidence: 99%

Diaphragmatic Dysfunction after Thoracic Operations

Gaissert

Wilcox

2016

Thorac cardiovasc Surg

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The perioperative management of diaphragmatic weakness and phrenic nerve dysfunction is complex, due to varied etiologies and clinical presentations. The factors leading to diaphragmatic weakness may culminate after the operation with transient or persistent respiratory failure. This review discusses diaphragmatic disorders and postoperative respiratory failure caused by unilateral or bilateral diaphragmatic impairment. The origins of neuromuscular weakness involving the diaphragm are diverse, and often lie within the domains of different medical specialties, with only a portion of the condition related to surgical intervention. Consideration of underlying etiologies for any individual patient requires thorough multidisciplinary review. The most important clinical scenarios compounding diaphragmatic weakness, including acute myasthenic states, persistent neuromuscular blockade, and surgical injury to the phrenic nerve or diaphragm, are accessible to attentive surgeons. Awareness of the signs and symptoms of undiagnosed weakness, preoperative pursuit of its diagnosis, knowledge of surgical alternatives to phrenic nerve resection, and cooperative skills in the multidisciplinary management of myasthenia all are crucial to improve patient outcomes.

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Lambert-Eaton myasthenic syndrome during anesthesia: a report of 37 patients

Cited by 20 publications

References 13 publications

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Mapping the current evidence on the anesthetic management of adult patients with neuromuscular disorders—a scoping review

Lambert Eaton Myasthenic Syndrome diagnosed following prolonged neuromuscular blockade: beware the patient with weak legs

Diaphragmatic Dysfunction after Thoracic Operations

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