Anesthesia Management in a Patient with Myasthenia Gravis Who Underwent Aortic Valve Replacement Surgery

Year 2018, Volume: 21 Issue: 2, 177 - 179, 19.08.2018

Tülay Örki Deniz Avan

Abstract

General
anesthesia was planned for aortic valve replacement in a 67-year-old patient
with type IIa myasthenia gravis (MG) who was on pyridostigmine treatment for 18
months. Pyridostigmine treatment was continued until the morning of the
surgery. Propofol, fentanyl, and rocuronium were administered for the induction
of anesthesia and sevoflurane for maintaining the surgery. The surgery was
performed using standard sternotomy and under antegrade hypothermic blood
cardioplegia for cardiopulmonary bypass. The cardiopulmonary bypass was uneventful.
At the end of the surgery, remifentanil infusion was discontinued; the patient
was transferred to the intensive care unit of cardiovascular surgery and was
intubated. At 8 h postoperatively, the patient, after meeting the criteria for
extubation, was extubated. No problem occurred during the follow-up. The
patient was discharged on postoperative day 5 without any complications. In
conclusion, open heart surgery accompanied by cardiopulmonary bypass can be
safely performed in patients with MG by careful preoperative evaluation and
postoperative follow-up, administration of muscle relaxant in reduced doses,
and continuation of treatment with anticholinesterase inhibitors.

Keywords

Myasthenia gravis, aortic valve replacement surgery, anesthesia management

Aort Kapak Replasmanı Geçiren Myasthenia Gravisli Hastada Anestezi Yönetimi

Abstract

Altmış
yedi yaşında, 18 aydır pridostigmin tedavisi alan tip IIa myasthenia gravisli
(MG) hastaya aort kapak replasmanı için genel anestezi planlandı. Piridostigmin
tedavisine ameliyat sabahı devam edildi. Anestezi indüksiyonunda propofol,
fentanil ve rokuronyum, idamede sevofluran kullanıldı. Operasyon standart
sternotomi ve heparinizasyonu takiben kardiyopulmoner baypasta antegrad
hipotermik kan kardiyoplejisiyle gerçekleştirildi. Kardiyopulmoner baypastan
sorunsuz çıkıldı. Operasyon bitiminde remifentanil infüzyonu kesildi, hasta
entübe şekilde kardiyovasküler cerrahi yoğun bakım ünitesine transfer edildi.
Postoperatif 8. saatte ekstübasyon kriterleri sağlandıktan sonra ekstübe
edildi. Takip dönemi sorunsuzdu. Hasta 
postoperatif  5. gün komplikasyonsuz
olarak taburcu edildi. Sonuç olarak MG’li hastalarda dikkatli bir preoperatif
değerlendirme ve postoperatif takip, azaltılmış dozlarda kas gevşetici
kullanımı ve antikolinesteraz tedaviye devam edilmesi ile kardiyopulmoner
baypas eşliğinde açık kalp cerrahisi güvenle uygulanabilir.

Keywords

Miyasthenia gravis, aort kapak replasmanı, anestezi yönetimi

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