SPECIFIC MANAGEMENT OF MYASTHENIA GRAVIS IN PATIENTS UNDERGOING ABDOMINAL CANCER SURGERIES
https://doi.org/10.21292/2078-5658-2019-16-3-48-54
Abstract
21 clinical cases of abdominal cancer surgery in patients with concomitant myasthenia gravis are combined with the use of the “pharmacological duet” of rocuronium ‒ sugammadex and the mandatory monitoring of neuromuscular conduction. In all cases, surgery procedures were performed under combined anesthesia with sevoflurane and low-dose epidural ropivacaine + fentanyl + norepinephrine. In all cases, except one, when the mechanical ventilation was planned and determined by the severity of the operation, blood loss and hypothermia, it was possible to reliably restore the spontaneous breathing immediately after the end of the operation. The necessity of an individual approach to patients suffering from myasthenia gravis, due to the difference in its severity and degree of compensation, is clearly shown. It was especially emphasized that with subcompensated state, incomplete efficacy of sugammadex is possible and additional intravenous administration of anticholinesterase drugs may be required (2 cases). In addition, in severe myasthenia gravis, a discrepancy is possible between “safe” TOF = 90% and clinical signs of residual respiratory failure (1 case).
About the Authors
V. E. GRUZDEV
Blokhin Russian Oncology Research Center
Russian Federation
Russian Federation
Vadim E. Gruzdev
Candidate of Medical Sciences, Anesthesiologist and Emergency Physician of Superior Merritt, Head of Anesthesiology and Intensive Care Department.
23, Kashirskoye Highway, Moscow, 115478
E. S. GOROBETS
Blokhin Russian Oncology Research Center
Russian Federation
Russian Federation
Evgeny S. Gorobets
Doctor of Medical Sciences, Professor, Leading Researcher, Anesthesiologist and Emergency Physician of Superior Merritt.
23, Kashirskoye Highway, Moscow, 115478
V. V. KULАBUKHOV
Blokhin Russian Oncology Research Center
Russian Federation
Russian Federation
Vladimir V. Kulabukhov
Candidate of Medical Sciences, Anesthesiologist and Emergency Physician, Head of Anesthesiology and Intensive Care Department.
23, Kashirskoye Highway, Moscow, 115478
А. А. MOROZOVА
Blokhin Russian Oncology Research Center
Russian Federation
Russian Federation
Aleksandra A. Morozova
Anesthesiologist and Emergency Physician
23, Kashirskoye Highway, Moscow, 115478
M. А. АNISIMOV
Blokhin Russian Oncology Research Center
Russian Federation
Russian Federation
Mikhail A. Anisimov
Anesthesiologist and Emergency Physician of Superior Merritt.
23, Kashirskoye Highway, Moscow, 115478
References
1. Zilber A.P. Dykhatelnaya nedostatochnost. [Respiratory failure]. Moscow, Meditsina Publ., 1989, pp. 237-241.
2. Abel M., Eisenkraft J.B. Anesthetic implication of myasthenia gravis. Mountsinai J. Med., 2002, vol. 69, no. 1-2, pp. 31-37.
3. Baraka A. Anaesthesia and myasthenia gravis. Canad. J. Anaesthisiol., 1992, vol. 39, pp. 476-486.
4. Blichfeldt-Lauridsen L., Hansen B.D. Anesthesia and myasthenia gravis. Review Article. Acta Anaesthiol. Scand., 2012, vol. 56, pp. 17-22.
5. Chihiro Shingu, Taichi Nishida et al. Sugammadex is Safe and effective for patients with myasthenia gravis. Anesth. Clinic. Res., 2011, vol. 2, is. 2, URL: https://www.omicsonline.org/sugammadex-is-safe-and-effective-forpatients-with-myasthenia-gravis-2155-6148.1000122.php?aid=114
6. de Boer H.D., Shields M.O., Booij L. Reversal of neuromuscular blockade with sugammadex in patients with myasthenia gravis: A case series of 21 patients and review of the literature. Eur. J. Anaesthesiol., 2014, vol. 31, issue 12, pp. 715-721.
7. de Boer H.D., van Egmond J., Driessen J.J. et al. Sugammadex in patients with myasthenia gravis: correspondence. Anaesthesia, 2010, vol. 65, pp. 653.
8. Eisenkraft J.B., Book W.J., Papatestas A.E. et al. Sensitivity to vecuronium in myasthenia gravis: A dose response study. Can. J. Anaesth., 1990, vol. 37, pp. 301-306.
9. Gritti P., Sgarzi M., Carrara B. et al. A standardized protocol for the perioperative management of myasthenia gravis patients. Experience with 110 patients. Acta Anaesthesiol. Scand., 2012, vol. 56, pp. 66-75.
10. Haes A.D., Proost J.H., Kuks J.B.M. et al. Pharmacokinetic/pharmacodynamics modeling of rocuronium in myasthenic patients is improved by taking into account the number of unbound acetylcholine receptors. Anesthesia&Analgesia, 2002, vol. 95, pp. 588-596.
11. Hübler M., Litz R.J., Albrecht D.M. Combination of balanced and regional anaesthesia for minimally invasive surgery in a patient with myasthenia gravis. Eur. J. Anaesthesiol., 2000, vol. 17, pp. 325-328.
12. Kiran U., Choudhury M., Saxena N. et al. Sevoflurane as a sole anaesthetic agent forthymectomy in myasthenia gravis. Acta Anaesthesiologica Scandinavica, 2000, vol. 44, pp. 351-353.
13. Leventhal S.R., Orkin F.K., Hirsh R.A. Prediction of the Need for Postoperative Mechanical Ventilation in Myasthenia Gravis. Anesthesiology, 1980, vol. 53, pp. 26-30.
14. Maselli R.A. Pathophysiology of myasthenia gravis and Lambert-Eaton syndrome. Neurol. Clin., 1994, vol. 12, pp. 285-303.
15. Masters O.W., Bagshaw O.N., Anaesthetic consideratios in paediatric myasthenia gravis, review article. Autoimmune Diseases, 2011, vol. 2011.
16. Michael K.H., Silvestri N.J. Generalized Myasthenia Gravis. classification, clinical presentation, natural history, and epidemiology. Neurol. Clin., 2018, vol. 36, pp. 253-260.
17. Miller R.D. Miller’s Anesthesia, 6th edition. New York, Elsevier. Churchill Livingstone. 2004, pp. 1255-1281.
18. Nilsson E., Meretoja O.A. Vecuronium dose-response and maintenance requirements in patients with myasthenia gravis. Anesthesiology, 1990, vol. 73, pp. 28-32.
19. Paterson I.G., Hood J.R., Russel S.H. et. al. Mivacurium in the myasthenic patient. Br. J. Anaesth., 1994, vol. 73, pp. 494-498.
20. Phillips L.H. The epidemiology of myasthenia gravis. Neurol. Clin., 1994, vol. 12, pp. 263-271.
21. Savcenko M., Wendt G.K., Prince S.L. et al. Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur. J. Cardiothor. Surgery, 2002, vol. 22, pp. 978-983.
22. Seigne R.D., Scott R.P. Mivacurium chloride and myasthenia gravis. Br. J. Anaesth., 1994, vol. 72, pp. 468– 469.
23. Smith C.E., Donati F., Bevin D.R. Cumulative dose-response curves for atracurium in patients with myasthenia gravis. Can. J. Anaesth., 1989, vol. 36, pp. 402-406.
24. Unterbuchner C., Fink H., Blobner M. The use of sugammadex in a patient with myasthenia gravis. Anaesthesia, 2010, vol. 65, pp. 302-305.
25. Wainwright A.P., Brodrick P.M. Suxamethonium in myasthenia gravis. Anaesthesia, 1987, vol. 42, pp. 950-957.
Review
For citations:
GRUZDEV V.E., GOROBETS E.S., KULАBUKHOV V.V., MOROZOVА А.А., АNISIMOV M.А. SPECIFIC MANAGEMENT OF MYASTHENIA GRAVIS IN PATIENTS UNDERGOING ABDOMINAL CANCER SURGERIES. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2019;16(3):48-54. (In Russ.) https://doi.org/10.21292/2078-5658-2019-16-3-48-54
Email this article 