Myasthenia gravis and pregnancy: anaesthetic management – a series of cases

Almeida, Carlos Rodrigues; Coutinho, Estér; Moreira, Diana; Santos, Ernestina; Aguiar, José Lamartine de Andrade

doi:10.1097/eja.0b013e32833e263f

Cited by 45 publications

(25 citation statements)

References 26 publications

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“…Vaginal delivery is the first choice for patients with well‐controlled MG because the uterine muscles are unaffected by the presence of acetylcholine receptor antibodies . However, maternal voluntary muscle weakness can be exacerbated during expulsive efforts; thus, assistance might be required in the second stage using vacuum extraction …”

Section: Discussionmentioning

confidence: 99%

“…Adequate control of labor pains is essential to reduce the number of cesarean sections and the dystocic vaginal delivery rate . At the same time, ELA has a fundamental role in preventing the administration of systemic analgesia, which may have a depressive effect on the respiratory system …”

Section: Discussionmentioning

confidence: 99%

“…Although the uterine muscles, which consist of smooth muscles, are rarely affected in MG‐complicated pregnancies, voluntary muscle weakness can be exacerbated due to the expulsive efforts during the second stage of labor, and fatigability can contribute to respiratory distress . Thus, easing the stress and controlling pain are crucial to managing labor in cases of maternal MG, especially for those with systemic symptoms . The cesarean section rate tends to be higher among mothers with MG, presumably because of prolonged labor due to maternal fatigue.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of labor and delivery in myasthenia gravis: A new protocol

Tsurane

Tanabe

Matsuda

et al. 2019

J of Obstet and Gynaecol

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Aim Pregnancy with myasthenia gravis (MG) is known to be associated with an increased cesarean section rate, presumably due to maternal fatigue during labor. Although epidural labor analgesia (ELA) appears to be a good option for circumventing maternal fatigue, a protocol for managing MG deliveries has not been established. This study, based on a review of our case series, aimed to evaluate the validity of our management protocol for maternal MG, in which ELA is used depending on MG severity. Methods Parturients with systemic muscle weakness or worsening symptoms were classified as Category A (A), and those without symptoms were classified as Category B (B). In A, ELA was given at the onset of labor. Immediate vacuum delivery was done once the fetal head descended to station +2. For B, spontaneous vaginal delivery was chosen. The duration, blood loss, fetal weight, Apgar score and MG symptoms on post‐partum day (PPD) 1, 14 and 30 were recorded. Results Six patients were enrolled. Four were classified in A, and two were classified in B. No adverse events occurred during labor. Transvaginal delivery was successfully achieved in all the patients. Symptoms of MG were well‐controlled. MG symptoms were stable on PPD 1 in all the patients although two patients complained of worsening symptoms after PPD 14. Conclusion Women with MG can safely undergo spontaneous or operative vaginal delivery. ELA is a good option for circumventing the effects of maternal fatigue on delivery. Our protocol may lower the cesarean section rate in maternal MG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of labor and delivery in myasthenia gravis: A new protocol

Tsurane

Tanabe

Matsuda

et al. 2019

J of Obstet and Gynaecol

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“…However, effects of these techniques on the respiratory system should be taken into consideration. For example, the interscalene approach to brachial plexus block may cause phrenic nerve blockade and subsequent diaphragm paralysis, which may worsen respiratory dysfunction . Myasthenia gravis patients have abnormal reactions to neuromuscular blocking drugs.…”

Section: Neuromuscular Transmission Disordersmentioning

confidence: 99%

Neuromuscular disease and anesthesia

Romero

Joshi

2013

Muscle and Nerve

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Patients with neuromuscular disease pose many anesthetic challenges and are at greater risk for perioperative complications, including respiratory or cardiovascular dysfunction and pulmonary aspiration. Therefore, these patients require special precautions, including interdisciplinary communication between primary care physicians, neurologists, physiatrists, surgeons, and anesthesiologists. Preoperative evaluation and optimization of comorbid conditions is critical. These patients may have adverse response to neuromuscular blocking drugs and the reversal drugs (e.g., neostigmine). They should be used with caution and titrated based on objective neuromuscular monitoring. Drugs that potentiate neuromuscular blocking drugs should also be avoided or their doses limited if possible. The risk of malignant hyperthermia in certain neuromuscular diseases mandates avoidance of triggering agents such as succinylcholine and inhaled anesthetics. Patients with neuromuscular disease may also be sensitive to sedative-hypnotics and opioids, which should be used judiciously. Finally, the postoperative period requires close monitoring due to increased risk of postoperative cardiorespiratory dysfunction.

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“…[172627] Myasthenia gravis should be adequately treated preoperatively with anticholinesterases and regional anesthesia is preferable if respiratory functions are not impaired. [28] Patients with multiple sclerosis should be administered succinylcholine cautiously and only if strongly indicated as they are at high risk of developing hyperkalemia and cardiac arrest due to up-regulation of nicotinic acetylcholine receptors. [29] The neuroprotection during perioperative period applies both for the general and regional anesthesia, but mannitol, dexamethasone and frusemide should be used judiciously as it can compromise uterine perfusion.…”

Section: Medical Diseases Affecting Anaesthetic Management During Prementioning

confidence: 99%

Pregnancy with co-morbidities: Anesthetic aspects during operative intervention

Bajwa

Ghuman

2013

Anesth Essays Res

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The presence of co-morbidities during pregnancy can pose numerous challenges to the attending anesthesiologists during operative deliveries or during the provision of labor analgesia services. The presence of cardiac diseases, endocrinological disorders, respiratory diseases, renal pathologies, hepatic dysfunction, anemia, neurological and musculoskeletal disorders, connective tissue diseases and many others not only influence the obstetric outcome, but can significantly impact the anesthetic technique. The choice of anesthesia during the pregnancy depends upon the type of surgery, the period of gestation, the site of surgery, general condition of patient and so on. Whatever, the anesthetic technique is chosen the methodology should be based on evidentially supported literature and the clinical judgment of the attending anesthesiologist. The list of co-morbid diseases is unending. However, the present review describes the common co-morbidities encountered during pregnancy and their anesthetic management during operative deliveries.

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Myasthenia gravis and pregnancy: anaesthetic management – a series of cases

Cited by 45 publications

References 26 publications

Management of labor and delivery in myasthenia gravis: A new protocol

Management of labor and delivery in myasthenia gravis: A new protocol

Neuromuscular disease and anesthesia

Pregnancy with co-morbidities: Anesthetic aspects during operative intervention

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