Dilemmas of an Anesthesiologist to assure a patient with Myasthenia Gravis safely walks the tightrope through the peri-operative course

Authors

  • Amrusha Raipure Associate Professor, Department of Anaesthesiology, All India Institute of Medical Sciences,Nagpur, India
  • Deepak Ruparel Assistant Professor, Department of Anaesthesiology, Government Medical College & Hospital,Nagpur, India
  • Pallavi Sharma Assistant Professor, Department of Anaesthesiology, Government Medical College, Bharatpur, Rajasthan, India

Keywords:

Myasthenia gravis; thymectomy; thoracoscopic surgery; Acetylcholine receptors; mechanical ventilation; neuromuscular blocking agents

Abstract

Background: Myasthenia gravis [MG] is an autoimmune disorder of neuromuscular transmission. A significant percentage of patients diagnosed with this disease benefit from thymectomy. It poses unique peri-operative challenges to the anaesthesiologists. Case: A 27 year old male diagnosed with MG-stage III, on Pyridostigmine, Azathioprine & Methylprednisolone, was posted for thoracoscopic thymectomy. This case report documents our experience about managing the patient’s ongoing treatment peri-operatively, judicious use of neuromuscular blockers assisted by neuromuscular & bis monitoring; management of intra-operative complications such as ventricular tachycardia and continuously rising end tidal carbon dioxide. Reversal of the neuromuscular blockade was guided by monitoring the train of four count / ratio.Conclusion: The perioperative concerns include-Assessment of Airway & respiratory muscle strength, implications of superior mediastinal mass, managing the neuromuscular blockers intra-operatively & identifying the risk factors to decide the need of postoperative ventilation. Neuromuscular monitoring is an absolute must.

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Published

2021-04-14

How to Cite

Raipure, A., Ruparel, D., & Sharma, P. (2021). Dilemmas of an Anesthesiologist to assure a patient with Myasthenia Gravis safely walks the tightrope through the peri-operative course. International Journal of Health and Clinical Research, 4(7), 152–154. Retrieved from https://ijhcr.com/index.php/ijhcr/article/view/1343