1/13. Sevoflurane as a sole anaesthetic for thymectomy in myasthenia gravis.myasthenia gravis is a challenging situation for anaesthesiologists due to its neuromuscular involvement. The main concerns are respiratory muscle weakness and side effects due to a heavy dose of anticholinesterases. This limits the use of sedatives, hypnotics and muscle relaxants. Inhalational anaesthetics are best suited. We describe our experience with sevoflurane as a sole anaesthetic in a child having juvenile-type myasthenia gravis with thymoma, who underwent thymectomy by midsternal incision. Very smooth and short duration of induction (35 s) and easy intubation within 60 s without use of muscle relaxant were the remarkable features. Sevoflurane in oxygen and nitrous oxide (MAC=0.5-0.7) was used for maintenance of anaesthesia. Recovery was smooth and fast with no residual respiratory insufficiency. Hence we found sevoflurane to be a highly suitable agent for thymectomy in mysthenia gravis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/13. Combination of balanced and regional anaesthesia for minimally invasive surgery in a patient with myasthenia gravis.A 45-year-old man with cryptorchism, who was known to suffer from generalized myasthenia gravis, was admitted to hospital for surgical treatment using laparoscopy. Such minimally invasive surgery requires good muscle relaxation. However, the use of neuromuscular blocking agents in patients with myasthenia gravis may lead to prolonged apnoea after operation, thus necessitating mechanical ventilation of the lungs. We used a combination of general anaesthesia (with desflurane), and epidural anaesthesia (with the amide local anaesthetic ropivacaine) to obtain excellent abdominal relaxation during surgery. Tracheal extubation was possible immediately after the operation and no adverse effects were observed. The patient was discharged from hospital on the second day after operation. The combination of regional and general anaesthesia for minimally invasive surgery in this patient permitted safe anaesthetic management.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
3/13. Perioperative management of a patient with congenital myasthenia gravis for elective caesarean section.Congenital disorders of neuromuscular transmission are commonly referred to as congenital myasthenia gravis because of their clinical similarity to the immune-mediated disease. Differentiation between the immune-mediated and congenital forms of the disease is important, because therapy established for the former may not be appropriate for patients with the latter presentation.The course of this rare neuromuscular disorder during pregnancy and its influence on anaesthesia remain largely unknown. We report on the case of a 32-year-old parturient suffering from congenital myasthenia gravis scheduled for elective caesarean section. The perioperative management of this patient who underwent the operation under spinal anaesthesia was reviewed.The effects of anaesthetic agents and techniques on the course of congenital myasthenic patients may need further review in the light of latest findings in the electrophysiology, genetic and therapeutic studies of this syndrome.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
4/13. Peri-operative management of patients for video assisted thoracoscopic thymectomy in myasthenia gravis.Three patients of myasthenia gravis, who under went video-assisted thoracoscopic surgery (VATS) were given general anaesthesia by propofol infusion and muscle relaxation by atracurium infusion. isoflurane was added to control depth of anaesthesia on the basis of haemodynamic changes during surgery. One lung ventilation (OLV) was achieved by placement of Carlens left sided double lumen bronchocatheter. Right-sided surgical approach was used to perform thymectomy. Contrary to claimed short duration of surgery, in first patient, OLV lasted for 10 hours 30 minutes and patient developed re-expansion pulmonary oedema. OLV in second and third patient was for six hours thirty minutes and three hours 45 minutes respectively. Morning dose of pyridostigmine was omitted and atracurium (0.1 mg/kg) was found to be satisfactory for intubation and relaxation was maintained with atracurium infusion to get desired monitored effect. We could not extubate our patients due to longer duration of surgery and the sequelae there off. Post-operative elective ventilation and spontaneous weaning off the atracurium effect was thus preferred.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
5/13. The ProSeal laryngeal mask in myasthenia gravis.This case describes the anaesthesia management of a patient with myasthenia gravis who required mastectomy with axillary lymph node clearance. After withholding medical therapy for the myasthenia preoperatively on the day of surgery, anaesthesia was maintained with halothane, nitrous oxide and a remifentanil infusion. Muscle relaxants were avoided, facilitated by the use of a ProSeal (Intravent, Orthofix, Maidenhead, United Kingdom) laryngeal mask airway for positive pressure ventilation. The ProSeal laryngeal mask airway is a new laryngeal mask device with a modified cuff and a drainage tube which has been shown to have advantages over older designs for use during positive pressure ventilation. The rationale for the management of this patient with myasthenia is discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
6/13. myasthenia gravis and pipecuronium--report of two cases.The use of pipecuronium in two patients with myasthenia gravis undergoing thymectomy is described. Neuromuscular function was monitored throughout using the train-of-four (TOF) mechanical twitch response. The cumulative dose-response to pipecuronium was determined in both patients during nitrous oxide-oxygen-narcotic anaesthesia. Both patients were sensitive to pipecuronium. The ED50 doses of pipecuronium were 11.6 and 11.1 micrograms.kg-1 and the ED95 doses were 35 and 33.3 micrograms.kg-1 in patients #1 and 2 respectively. edrophonium 1 mg.kg-1 and neostigmine 0.06 mg.kg-1 were administered to patients #1 and 2 respectively for antagonism of residual neuromuscular blockade at 25 per cent spontaneous recovery of first twitch (T1) of the TOF stimulation. As with other non-depolarizing muscle relaxants pipecuronium in reduced dosage and with careful neuromuscular monitoring can be used to provide surgical relaxation safely in patients with controlled myasthenia gravis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/13. Clinical use of atracurium in myasthenia gravis: a case report.A patient with myasthenia gravis was anaesthetized for thymectomy utilizing atracurium for maintenance of muscle relaxation. The patient was not taking anticholinesterase medications before surgery. Neuromuscular function was monitored by recording the train-of-four response to supramaximal stimulation of the ulnar nerve. Anaesthesia was induced with thiopentone and maintained with isoflurane and N2O in oxygen. Following complete recovery from a succinylcholine block for intubation, the patient developed complete neuromuscular block within two minutes after atracurium (5 mg) was administered. Evidence of recovery commenced 12 minutes later and was complete at 72 minutes. This rate of recovery is consistent with the recovery rate from atracurium during isoflurane anaesthesia in normal patients. atracurium appears to offer an advantage over other nondepolarizing muscle relaxants in patients with myasthenia gravis due to its shorter duration and less cumulative effect at the neuromuscular junction.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/13. A case of myasthenia gravis with thyrotoxicosis treated by combined subtotal thyroidectomy and total thymectomy.thyrotoxicosis occurring in conjunction with myasthenia gravis is rare. The usual treatment consists of medical control of the thyrotoxicosis, then thymectomy and later subtotal thyroidectomy. The case reported here concerns a 19-year-old girl who had surgical treatment for both lesions on the same occasion. With proper medical preparation, modern anaesthesia and respiratory care, the surgical treatment of both lesions can be accomplished in one stage.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/13. Delivery complicated by myasthenia gravis and epilepsy.The literature on the possible risk of myasthenia gravis complicating pregnancy and delivery is sparse and partly contradictory but some of the reports on the number of perinatal and neonatal deaths are alarming. epilepsy in pregnancy implies on approximately twofold risk of intervention in connection with labour. A pregnant patient with myasthenia gravis and epilepsy has recently been delivered. The case is reported and the considerations with regard to suitable anaesthesia and the two diseases are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/13. myasthenia gravis presenting during general anaesthesia for oesophagoscopy--a cautionary tale.We report myasthenia gravis presenting as dysphagia of acute onset in a 56-year-old female who had no other stigmata of the disease and who was generally well despite rheumatoid arthritis and hypothyroidism. She recovered respiratory function following a general anaesthetic for oesophagoscopy only when antimyasthenic treatment was instituted. She remains well to date. In patients who are known to have autoimmune diseases and who present with dysphagia, features of myasthenia gravis should be specifically sought.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
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