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Anesthesia for myasthenia gravis

Stefan Josef Schaller, Heidrun Lewald
INTRODUCTION: Sugammadex is the first clinical representative of a class of drugs called steroidal muscle relaxant encapsulators. Due to its 1:1 binding of rocuronium or vecuronium, sugammadex can reverse any depth of neuromuscular block and has therefore revolutionized the way anesthetists think about drug reversal. AREAS COVERED: This review gives an overview of the clinical pharmacology and efficacy of sugammadex in healthy patients as well as in patients with pre-existing diseases...
September 2016: Expert Opinion on Drug Metabolism & Toxicology
Raing Kyu Kim, Soon Yul Kim
Myasthenia gravis causes weakness and fatigue of the skeletal muscles, including respiratory muscles. When immobile surgical fields are needed, neuromuscular blocking agents (NMBAs) are often administered to block muscle activity, leading to an immobile surgical field and respiratory arrest. Acetylcholinesterase inhibitors are administered to reverse the muscle block, promoting spontaneous respiration for patient recovery. If immobile surgical fields are required in myasthenic patient operations, NMBAs should be administered...
March 2016: Journal of Lifestyle Medicine
Hiroto Matsuse, Takeshi Oshio, Kumiko Kishimoto, Haruo Nakayama
A 58-year-old man developed cough, sputum, and low-grade fever during immunosuppressive treatment with corticosteroids and cyclosporine for myasthenia gravis with recurrent thymoma. Since chest CT revealed diffuse nodular opacities in both lung fields, he was referred to our department. Mycobacterium abscessus was repeatedly cultured from his sputum, and he was diagnosed with pulmonary M. abscessus infection. Although both chest radiological findings and clinical symptoms were mild, he required treatment with immunosuppressive agents and systemic anesthesia for resection of the recurrent thymoma...
February 2016: Kekkaku: [Tuberculosis]
Weihua Lu, Tao Yu, Federico Longhini, Xiaogan Jiang, Xuemei Qin, Xiaoju Jin
UNLABELLED: Adequate preoperative evaluation and preparation for surgery are required to prevent prolonged mechanical ventilation after thymectomy, and facilitate the recovery of patients with myasthenia gravis (MG). The objective of this study was to identify the preoperative risk factors for extubation failure after thymectomy in patients with MG. METHODS: A retrospective study was conducted on 61 patients with MG who underwent extended thymectomy. Several factors were evaluated including patients' demographic data, preoperative medical therapies, medical history, and comorbidities...
2015: International Journal of Clinical and Experimental Medicine
Megana Ballal, Tracey Straker
Myasthenia gravis, a disorder of neuromuscular transmission, presents a unique challenge to the perioperative anesthetic management of morbidly obese patients. This report describes the case of a 27-year-old morbidly obese woman with a past medical history significant for myasthenia gravis and fatty liver disease undergoing bariatric surgery. Anesthesia was induced with intravenous agents and maintained with an inhalational and balanced intravenous technique. The nondepolarizing neuromuscular blocker Cisatracurium was chosen so that no reversal agents were given...
2015: Case Reports in Medicine
Michał Kowalczyk, Andrzej Nestorowicz, Katarzyna Stachurska, Anna Fijałkowska, Janusz Stążka
Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis...
June 2015: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Yoshihito Fujita, Satoru Moriyama, Satoshi Aoki, Saya Yoshizawa, Maiko Tomita, Taiki Kojima, Yukiko Mori, Naoko Takeuchi, Min-Hye So, Motoki Yano, Kazuya Sobue
Although maintaining anesthesia for myasthenia gravis (MG) with minimal muscle relaxants (MR) is common, the success rate of anesthetic management for MG without MR is not clear. We therefore retrospectively examined the success rate of anesthetic management for MG without MR among 66 consecutive cases of thymectomy for MG performed at our hospital between January 2004 and April 2010, before approval of using sugammadex. A total of 60 patients (90.9 %) were treated without MR (N group). Among the 60 cases, 17 (28...
October 2015: Journal of Anesthesia
Kenichiro Koda, Haruka Kimura, Masashi Uzawa, Norie Sambe, Takayuki Sugano, Takayuki Kitamura, Megumi Tagami
Myasthenia gravis (MG) is an autoimmune disease affecting neuromuscular junction, which is characterized by fluctuating muscle weakness and abnormal fatigability. The use of muscle relaxants is major concern in anesthetic management for patients with MG. Muscle relaxant is a practical tool to assure immobilization during surgery under general anesthesia Anesthetic management without muscle relaxants for patients with MG is challenging, because it is difficult to assure immobilization. However, pharmacological effects of muscle relaxants can be prolonged in patients with MG, resulting in the increased incidence of postoperative respiratory support...
October 2014: Masui. the Japanese Journal of Anesthesiology
Konstantin A Petrov, Emmanuelle Girard, Alexandra D Nikitashina, Cesare Colasante, Véronique Bernard, Leniz Nurullin, Jacqueline Leroy, Dmitry Samigullin, Omer Colak, Evgenii Nikolsky, Benoit Plaud, Eric Krejci
Terminal Schwann cells (TSCs) are key components of the mammalian neuromuscular junction (NMJ). How the TSCs sense the synaptic activity in physiological conditions remains unclear. We have taken advantage of the distinct localization of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) at the NMJ to bring out the function of different ACh receptors (AChRs). AChE is clustered by the collagen Q in the synaptic cleft and prevents the repetitive activation of muscle nicotinic AChRs. We found that BChE is anchored at the TSC by a proline-rich membrane anchor, the small transmembrane protein anchor of brain AChE...
September 3, 2014: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Amanda N Hopkins, Taghreed Alshaeri, Seth A Akst, Jeffrey S Berger
Women with neurologic conditions present a challenge during pregnancy and in the peripartum period. Given the low prevalence of these diseases during pregnancy, most management decisions are guided by retrospective reviews and case reports. This article reviews current literature for some of the more common or complex neurologic conditions affecting pregnancy with special consideration for anesthetic management. In particular, epilepsy; multiple sclerosis; primary intracranial hypertension; secondary intracranial hypertension-Arnold-Chiari malformations and intracranial neoplasms; spinal cord injury; neuromuscular junction disorders-myasthenia gravis; and hereditary neuromuscular disorders-myotonic dystrophy and spinal muscular atrophy will be discussed...
October 2014: Seminars in Perinatology
Valluvan Rangasamy, Kaushal Kumar, Amit Rai, Dalim Kumar Baidya
Literature on anesthetic management of juvenile myasthenia gravis (JMG) for thymectomy is limited. Recently, use of inhalational agents and total intravenous anesthesia with propofol and remifentanyl has been reported. All these techniques individually or in combination have been tried to avoid the use of muscle relaxant. We report successful use of sevoflurane as sole anesthetic agent for intubation and in combination with thoracic epidural anesthesia for intraoperative anesthetic management in a 5-year-old child with JMG...
April 2014: Journal of Anaesthesiology, Clinical Pharmacology
Eugene Postevka
Myasthenia gravis is an autoimmune neuromuscular disorder that causes the destruction and overall decrease in functional acetylcholine receptors at the neuromuscular junction. The resultant respiratory and cardiovascular implications are a primary cause of mortality; therefore, a complete and comprehensive understanding of this disorder is vital for the anesthesia provider. The case presented demonstrates the anesthetic challenges involved, with a focus on the overall approach, pharmacologic considerations, physiological changes, and an emphasis on preoperative optimization...
October 2013: AANA Journal
Stefan Josef Schaller, Heidrun Fink
Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium, it is able to reverse any depth of neuromuscular block. So far, it has been approved for use in adult patients and for pediatric patients over 2 years. Since its approval in Europe, Japan, and Australia, further insight on its use in special patient populations and specific diseases have become available...
2013: Core Evidence
Hajime Iwasaki, Kenichi Takahoko, Shigeaki Otomo, Tomoki Sasakawa, Takayuki Kunisawa, Hiroshi Iwasaki
PURPOSE: We report on two patients with ocular myasthenia gravis who received rocuronium, followed later by sugammadex to reverse neuromuscular blockade. Recovery was monitored simultaneously at the adductor pollicis muscle (APM) and the corrugator supercilii muscle (CSM). CLINICAL FEATURES: Two patients with ocular myasthenia gravis (case 1: 74 yr-old female, 54 kg; case 2: 71 yr-old male, 72 kg) were scheduled for surgery under general anesthesia. Neuromuscular blockade was induced with rocuronium 0...
December 2013: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
V I Stamov, V M Mizikov, P V Tsar'kov, E V Ageeva, D R Markar'ian, M A Danilov
This article presents a clinical case of colon disease surgical treatment in a 34-year old patient with. generalized myasthenia. Perioperative management peculiarities in these patients are clarified. Different approaches to anaesthesia choice were discussed on a case study. The importance of tactics individualization, rational drugs selection, including neuromuscular block reversal agents as well as intraoperative neuromuscular transmission monitoring.
March 2013: Anesteziologiia i Reanimatologiia
Erisa Nakamori, Keiichi Nitahara, Yasuyuki Sugi, Kiyoshi Katori, Akiko Matsuzaki, Kazuo Higa
We report a patient with myasthenia gravis whose rocuronium induced neuromuscular block was reversed with sugammadex. A 26-year-old man, 175 cm and 76 kg, with myasthenia gravis, was scheduled for extended thymectomy under general anesthesia. An epidural catheter was inserted at the T5-6 interspace before induction of general anesthesia. Anesthesia was induced with propofol and remifentanil. Rocuronium was given in divided doses to obtain > 95% neuromuscular block to intubate the trachea. The ED50 and ED95 of rocuronium for this patient were 0...
August 2013: Masui. the Japanese Journal of Anesthesiology
T Morita, H Tsukagoshi, D Kurosaki, T Sugaya, D Yoshikawa, H Shimada
The current study evaluated the neuromuscular responses following administration of sevoflurane in 14 patients with myasthenia gravis (MG) (I-IIb in Osserman's classification) scheduled for thymectomy and in 11 control patients (ASA I-II) who underwent elective surgery. The electromyographic (EMG) response of the abductor digiti minimi was measured following train-of-four (TOF) stimulation of the ulnar nerve every 20 s. After induction of anesthesia with a combination of 3-4 mg·kg(-1) thiopental and 1-2 μg·kg(-1) fentanyl with 66% N2O and oxygen, an inspired concentration of 4% sevoflurane was administered via a face mask for 7 min...
September 1996: Journal of Anesthesia
Miguel Angel Palomero Rodríguez, Teresa Pérez Mencía, Felipe Villar Alvarez, Yolanda Laporta Báez, Gloria María Santos Pérez, Andrés López García
Myasthenia gravis (MG) is an autoimmune disease with an incidence of 2-10/100,000 cases per year, characterized by muscle weakness secondary to destruction of postsynaptic acetylcholine receptors. In these patients, important perioperative issues remain unresolved, namely, optimal administration of cholinesterase inhibitors, risks of regional anesthesia, and prediction of need of postoperative mechanical ventilation. We describe the use of a low-dose spinal anesthesia in a patient with MG who was submitted for emergence exploratory laparotomy...
January 2013: Saudi Journal of Anaesthesia
Koji Kido, Tokujiro Uchida, Koshi Makita
Prolonged neuromuscular blockade is a relatively common complication of general anesthesia. Some previous reports have shown that positive serum anti-acetylcholine receptor antibody (AChR Ab) might contribute to this complication. We experienced a case of a 69-year-old woman with prolonged neuromuscular blockade after laparoscopic sigmoid colectomy under general anesthesia using rocuronium. A high level of anti-AChR Ab (45 nmol x l-1) was found in postoperative examination and the patient had progressive muscle weakness for six months after the operation...
April 2013: Masui. the Japanese Journal of Anesthesiology
Rita Sonzogni, Lorenzo Novellino, Alberto Benigni, Ilaria Busi, Magda Khotcholava, Angelica Spotti, Valter Sonzogni
Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care...
February 5, 2013: Pediatric Reports
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