Document Detail

Perioperative evaluation of myasthenia gravis.
MedLine Citation:
PMID:  18338538     Owner:  NLM     Status:  MEDLINE    
Myasthenia gravis (MG) is the prototype of antibody mediated autoimmune disease and results from the production of autoantibodies against the acetylcholine receptor (AChR) of the neuromuscular synapse. Adequate preoperative evaluation of the myasthenic patient must be carried out carefully. Age, sex, onset and duration of the disease as well as the presence of thymoma may determine the response to thymectomy. Specific attention should be paid to voluntary and respiratory muscle strength. The preoperative preparation of MG patients is essential for the success of surgery. It depends on the severity of clinical status and changes if myasthenic patients receive anticholinesterase therapy. Myasthenic patients may have little respiratory reserve, and hence depressant drugs for preoperative premedication should be used with caution and avoided in patients with bulbar symptoms. The anaesthetic management of myasthenic patient must be individualized in according to the severity of the disease and the type of surgery required. The use of regional or local anaesthesia seems warranted whenever possible. General anaesthesia can be performed safely when patient is optimally prepared and neuromuscular transmission is adequately monitored during and after surgery. Adequate postoperative pain control, pulmonary toilet, and avoidance of drugs that interfere with neuromuscular transmission will facilitate tracheal extubation. Myasthenia gravis is a disease with many implications for the safe administration of anaesthesia. The potential for respiratory compromise in these patients requires the anaesthesiologist to be familiar with the underlying disease state, as well as the interaction of anaesthetic and non-anaesthetic drugs with MG.
Alexander Cardone; Elisabetta Congedo; Paola Aceto; Rossella Sicuranza; Elisabetta Chinè; Francesca Caliandro; Germano De Cosmo
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annali italiani di chirurgia     Volume:  78     ISSN:  0003-469X     ISO Abbreviation:  Ann Ital Chir     Publication Date:    2007 Sep-Oct
Date Detail:
Created Date:  2008-03-14     Completed Date:  2008-07-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372343     Medline TA:  Ann Ital Chir     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  359-65     Citation Subset:  IM    
Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Roma, Italy.
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MeSH Terms
Intraoperative Care
Myasthenia Gravis / diagnosis*,  surgery*
Postoperative Care
Preoperative Care

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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