Anesthetic Management of a Patient With Antimuscle-Specific Kinase Antibody-Positive Myasthenia Gravis Undergoing an Open Cholecystectomy

Abstract

Myasthenia gravis (MG) is an autoimmune disease characterized by the production of antibodies against the acetylcholine receptor, muscle-specific kinase (MuSK), or other proteins at the neuromuscular junction. MG with antibodies against MuSK (MuSK-MG) has been described recently. Here, we report the first case of anesthetic management of a patient with MuSK-MG undergoing an open cholecystectomy. In our case, propofol and remifentanil-based anesthesia were used for successful management without using muscle relaxants. Patients with MuSK-MG have predominantly ocular, bulbar, and respiratory symptoms that may increase the risk of aspiration. Anesthesiologists need to pay attention to perioperative respiratory failure and respiratory crisis.

Effect of creatine phosphate sodium on bispectral index and recovery quality during the general anaesthesia emergence period in elderly patients: A randomized, double-blind, placebo-controlled trial

“…The BIS value during surgery can have an impact on the quality of the recovery in elderly patients under general anaesthesia; and fluctuations in BIS values might be obvious at the point of the initial skin incision, when cutting the gallbladder, suturing the peritoneum, and during final skin closure in patients undergoing transabdominal cholecystectomy. 14 , 15 Thus, this present study recorded and compared the BIS values of patients in the two groups at these time-points during the surgical procedure.…”

Perioperative management of the patient with Myasthenia gravis

“…We also compared the use of anestesia total intravenosa (total intravenous anesthesia) carried out with propofol and remifentanil versus general anesthesia balanced with desflurane and remifentanil for patients with MG. It was evidenced that in the group that received desflurane, there was a greater decrease in turn-over number (TOF) values compared to the group that received propofol 3 .…”

“…Although it is widely accepted that MG is a condition caused by antibodies, the origin remains uncertain. However, the thymus gland becomes a possible generator of the autoimmune process 3 .…”

Rosszindulatú vesedaganat eltávolítása myasthenia gravis miatt kezelt betegnél

“…A csökkent fájdalomcsillapító igény, kisebb szöveti károsodás, a jobb légzésfunkció, rövidebb ápolási idő, kozmetikai előnyök jelenthetik a laparoszkópia előnyeit. A myasthenia gravis diagnosztikájában elengedhetetlen az elektromiográfia, mellkas CT (thymus eltérés kizárása miatt), tensilon (edrophonium)-teszt, acetilkolin-receptor ellenes antitest-titer meghatározása (3,4,5). A kezelés során antikolinészteráz/pyridostigmin (Mestinon) adandó, ez a készítmény gátolja azt az enzimet, amelyik felelős az acetilkolin hidrolíziséért.…”