Delayed Postoperative Arousal following Remifentanil-based Anesthesia in a Myasthenic Patient Undergoing Thymectomy

Baraka, Anis; Haroun-Bizri, Sania; Gerges, Frederic J.

doi:10.1097/00000542-200402000-00055

Cited by 17 publications

(11 citation statements)

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“…Therefore we could lower the dose of remifentanil for general anaesthesia in our patients. This may be one of the reasons why we observed no clinically important differences in the duration of remifentanil action in our patients also receiving pyridostigmine in contrast to the experiences described by Baraka and colleagues [7]. Excellent analgesia enabled us also to minimize the dose of atracurium to facilitate tracheal intubation during the induction of anaesthesia.…”

Section: R Mahajan Ascoms Jammu Jammu and Kashmir Indiasupporting

confidence: 52%

“…As remifentanil is not a substrate for pseudocholinesterase the metabolism of remifentanil is not affected by a cholinesterase inhibitor [6]. Baraka and colleagues [7] did, however, report a delayed postoperative arousal for 12 h following sevoflurane and remifentanil anaesthesia in a patient with myasthenia gravis undergoing thymectomy. Those authors believed that delayed postoperative arousal was due to prolonged remifentanil metabolism caused by pyridostigmine.…”

Section: R Mahajan Ascoms Jammu Jammu and Kashmir Indiamentioning

confidence: 99%

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Changes in bispectral index values during lumbar arthrodesis *

Barrera

Fernández-Galinski

Arbonés

et al. 2005

European Journal of Anaesthesiology

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Section: R Mahajan Ascoms Jammu Jammu and Kashmir Indiasupporting

confidence: 52%

Section: R Mahajan Ascoms Jammu Jammu and Kashmir Indiamentioning

confidence: 99%

Changes in bispectral index values during lumbar arthrodesis *

Barrera

Fernández-Galinski

Arbonés

et al. 2005

European Journal of Anaesthesiology

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“…[13] However, there are reports of delayed postoperative recovery after remifentanyl infusion possibly due to inhibition of esterase degradation of remifentanyl by anticholinesterase. [10]…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane and thoracic epidural anesthesia for trans-sternal thymectomy in a child with juvenile myasthenia gravis

Rangasamy

Kumar

Rai

et al. 2014

J Anaesthesiol Clin Pharmacol

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Literature on anesthetic management of juvenile myasthenia gravis (JMG) for thymectomy is limited. Recently, use of inhalational agents and total intravenous anesthesia with propofol and remifentanyl has been reported. All these techniques individually or in combination have been tried to avoid the use of muscle relaxant. We report successful use of sevoflurane as sole anesthetic agent for intubation and in combination with thoracic epidural anesthesia for intraoperative anesthetic management in a 5-year-old child with JMG.

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“…[412] We did not notice a prolonged duration of action for remifentanil, which is a concern in patients with JMG taking AChEIs or with decreased levels of plasma esterases from preoperative plasmapheresis. [13]…”

Section: Discussionmentioning

confidence: 99%

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

et al. 2011

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Background:Juvenile myasthenia gravis (JMG) is the rare form of myasthenia gravis presenting in childhood and adolescence. When medical management fails, thymectomy is offered for these patients. Complete resection of the thymus is best achieved through transsternal thymectomy. Anesthetic management of patients with JMG is challenging, particularly in regards to the goals of postoperative pain control, respiratory function, and extubation.Methods:We retrospectively reviewed the medical records of 13 patients, ranging in age from 6 to 22 years, who underwent transsternal thymectomy for JMG. Information on patient demographics, characteristics of their disease and treatment, anesthetic management, and postoperative course were collected.Results:All patients had undergone multiple treatment modalities and presented for surgery because of inadequate symptom control with medical management. As expected for a pediatric population, anesthesia induction was age dependent. 40% of the patients underwent an inhalation induction and 60% underwent an intravenous induction. Anesthesia was maintained with a low-dose inhalation agent in all patients, supplemented in 84% of patients with a remifentanil infusion, and in 69% of patients with an epidural infusion. Muscle relaxants were avoided in all patients. With this regimen, 92% of patients could be extubated successfully in the operating room.Conclusion:We found that avoidance of muscle relaxants and use of remifentanil with a low-dose hypnotic agent provided a stable intraoperative course, facilitated rapid emergence, and allowed early extubation in patients with JMG undergoing transsternal thymectomy. Epidural analgesia reduced the need for intra- and postoperative intravenous opioids and did not have an adverse effect on respiratory strength.

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Delayed Postoperative Arousal following Remifentanil-based Anesthesia in a Myasthenic Patient Undergoing Thymectomy

Cited by 17 publications

References 0 publications

Changes in bispectral index values during lumbar arthrodesis *

Changes in bispectral index values during lumbar arthrodesis *

Sevoflurane and thoracic epidural anesthesia for trans-sternal thymectomy in a child with juvenile myasthenia gravis

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

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