1/3. neuromuscular monitoring in myasthenic syndrome.We describe the anaesthetic management of a 72-year-old man with myasthenic syndrome. Pre-operatively, he was treated with 3,4-diaminopyridine and showed a strong hand grip. During general anaesthesia with nitrous oxide and sevoflurane in oxygen, a mechanomyograph and two accelerographs were set up for the hands and left foot to monitor neuromuscular function. Insufficient force and acceleration of contraction with 1 Hz stimulation was observed in the hands. In the foot, the twitches produced by 1 Hz and train-of-four stimulation could barely be detected using the accelerograph, and the train-of-four ratio fluctuated between 70 and 100%. No neuromuscular blocking drugs were used during surgery. After discontinuation of sevoflurane, responses to train-of-four stimulation remained small, but a strong response to tetanic stimulation was observed, with post-tetanic facilitation. Extubation was successful, and recovery from anaesthesia was uneventful. Tetanic stimulation and post-tetanic facilitation are important in monitoring neuromuscular function in patients with myasthenic syndrome whose train-of-four responses are insufficient.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/3. Epidural analgesia in Eaton-Lambert myasthenic syndrome. Effects on respiratory function.The anaesthetic management of a patient with Eaton-Lambert myasthenic syndrome undergoing thoracotomy is described. Epidural anaesthesia, in combination with a light level of general anaesthesia, provided good operating conditions and postoperative analgesia. Pulmonary function and ventilatory responses to carbon dioxide and hypoxia were measured before operation. These tests were repeated after the epidural administration of 8 ml 2% lignocaine before surgery and after 2 mg morphine sulphate in 10 ml saline postoperatively. Minor reductions in some of the ventilatory parameters were observed. The epidural technique appears to be a useful and safe method by which to manage patients with Eaton-Lambert syndrome undergoing thoracotomy.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/3. The myasthenic syndrome: anaesthesia in a patient treated with 3.4 diaminopyridine.A case of anaesthesia in a patient with myasthenic syndrome treated with 3.4 diaminopyridine is described. Despite symptomatic improvement and an improved electromyogram (EMG) on treatment, extreme sensitivity to neuromuscular block occurred with vecuronium. Antagonism of block was poor with an anticholinesterase, while oral 3.4 diaminopyridine improved neuromuscular transmission further. A combination of anticholinesterase with aminopyridine may be the antagonistic combination of choice in this condition.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |