Remifentanil in myasthenia gravis

Mostafa, S.M.; Hughes, E. O.

doi:10.1046/j.1365-2044.1998.537s-az0584s.x

Cited by 13 publications

(6 citation statements)

References 2 publications

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“…One approach would be to blunt the cardiovascular response to laryngoscopy with up to 50 µg/kg of alfentanil and intubate without muscle relaxant 25. Remifentanil use in myasthenia gravis has also been described 26. Where muscle relaxation is required, the use of reduced-dose rocuronium and subsequent reversal with sugammadex has been described in myasthenic patients 27…”

Section: Discussionmentioning

confidence: 99%

New diagnosis myasthenia gravis and preeclampsia in late pregnancy

2015

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SUMMARYMyasthenia gravis is a chronic autoimmune disease of neuromuscular transmission resulting in fatigable skeletal muscle weakness. Preeclampsia is a multisystem disease of pregnancy which is characterised by hypertension and involvement of one or more organ systems. Both diseases are responsible for considerable morbidity and mortality for mother and fetus. The occurrence of both preeclampsia and myasthenia gravis in pregnancy is very rare, and conflicts arise when considering the optimal management of each disease.We present a case of a parturient who was newly diagnosed with both myasthenia gravis and preeclampsia in late pregnancy. Myasthenia treatment was started with prednisolone and pyridostigmine, and delivery was by caesarean section at 37 weeks gestation under spinal anaesthesia. Postnatally, the patient developed worsening of myasthenia and preeclampsia symptoms. We consider the anaesthetic implications for both diseases and describe our approach for the management of this case. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

New diagnosis myasthenia gravis and preeclampsia in late pregnancy

2015

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“…Remifentanil has also been proposed as a useful maintenance agent for myasthenic patients who are not receiving a neuromuscular blocking agent (6). However, one author cautioned that emergence may be delayed by slow breakdown of remifentanil in the presence of anticholinesterase agents (14), and reported a 19‐year‐old myasthenic female who received 30 μg·kg −1 of remifentanil over 2 h, and had a delay of 12 h until the return of spontaneous ventilation and the ability to follow commands.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, the use of nondepolarizing neuromuscular blocking agents can result in prolonged blockade. Several authors have proposed anesthetic techniques that eliminate the use of neuromuscular blocking agents to avoid these problems (3–6). There are several methods for tracheal intubation without using neuromuscular blocking agents, including the use of potent inhalational anesthetic agents, pure i.v.…”

Section: Introductionmentioning

confidence: 99%

Rapid sequence intubation without a neuromuscular blocking agent in a 14‐year‐old female patient with myasthenia gravis

Politis

Tobias

2006

Pediatric Anesthesia

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The anesthesia care of a 14-year-old female patient with an acute exacerbation of myasthenia gravis (MG) and a full stomach who required emergency surgery for placement of a hemodialysis catheter is described. A nonventilated rapid sequence induction was successful with the use of propofol, lidocaine, remifentanil, cricoid pressure and no neuromuscular blocking agent. Although the use of combinations of i.v. anesthetic agents have been suggested for tracheal intubation without the need for neuromuscular blocking agents, none of these techniques has been advocated for rapid sequence intubation. We review existing literature on the topic of tracheal intubation using remifentanil and propofol without a neuromuscular blocking agent and on the topic of tracheal intubation of patients with MG using i.v. anesthesia and no neuromuscular blocking agents.

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“…Following surgery, although planned extubation is usually possible, postoperative care in a high‐dependency area has been recommended where rapid respiratory support can be instituted if necessary [2]. Several authors have reported the use of TIVA in patients with myasthenia followed by HDU care [3, 4].…”

mentioning

confidence: 99%

“…Remifentanil is ideal in this situation because of its potent analgesic effects, the ability to provide apnoea and hence use controlled ventilation with minimal effects on neuromuscular transmission and a rapid offset. Its use in myasthenia gravis has previously been described [4].…”

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confidence: 99%