Anestesia en el paciente con patología neuromuscular
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Beatriz Forés, Ana Manzano, Patricia Urrengoetxea, Luciano Aguilera
Servicio de Anestesiología y Reanimación. Hospital de Basurto. Bilbao. Bizkaia. España UE.
Gac Med Bilbao. 2006; 103: 79-89
Resumen
Las enfermedades del músculo esquelético y del sistema nervioso periférico se denominan conjuntamente enfermedades neuromusculares (ENM). Desde el punto de vista de la anestesia estas enfermedades presentan síntomas variados y tienen un alto riesgo durante la anestesia general. La administración de succinilcolina y de anestésicos volátiles puede causar muchos problemas. Bajo circustancias especiales los opioides, los relajantes musculares no despolarizantes y los anestésicos intravenosos pueden también interferir con este tipo de desórdenes. Las complicaciones durante o después de la anestesia pueden dar lugar a hipertermia maligna o reacciones del tipo de la hipertermia maligna y a cambios primarios o secundarios en relación con la patología neuromuscular subyacente. Por ello el manejo perioperatorio debe ser determinado individualmente para garantizar la máxima seguridad de cada paciente. El propósito de esta revisión es clasificar las enfermedades neuromusculares de acuerdo al lugar de la lesión primaria y revisar los procedimientos anestésicos más seguros para cada tipo de patología.
Palabras clave: Anestesia, enfermedades neuromusculares.
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| Anestesia para pacientes con timectomía transesternal para miastenia gravis juvenil |
Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis. Stephenson L, Tkachenko I, Shamberger R, Seefelder C. Department of Anesthesiology, University of Wisconsin, Madison WI, USA. Saudi J Anaesth. 2011 Jan;5(1):25-30.Abstract 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. http://www.saudija.org/temp/SaudiJAnaesh5125-8008248_221442.pdf |
| Manejo anestésico para timectomía en un paciente con miastenia gravis e hipertiroidismo no controlado |
Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy. Datt V, Tempe DK, Singh B, Tomar AS, Banerjee A, Dutta D, Bhandari H. Department of Anesthesiology and Intensive Care and Cardiothoracic Surgery, G. B. Pant Hospital, New Delhi, India. dattvishnu@yahoo.comAnn Card Anaesth.2010 Jan-Apr;13(1):49-52.Abstract The relationship between myasthenia gravis (MG) and other autoimmune disorders like hyperthyroidism is well known. It may manifest earlier, concurrently or after the appearance of MG. The effect of treatment of hyperthyroidism on the control of MG is variable. There may be resolution or conversely, deterioration of the symptoms also. We present a patient who was diagnosed to be hyperthyroid two and half years before the appearance of myasthenic symptoms. Pharmacotherapy for three months neither improved the myasthenic symptoms nor the thyroid function tests. Thymectomy resulted in control of MG as well as hyperthyroidism. In conclusion, effective control of hyperthyroidism in the presence of MG may be difficult. The authors opine that careful peri-operative management of thymectomy is possible in a hyperthyroid state. http://www.saudija.org/article.asp?issn=1658-354X;year=2011;volume=5;issue=1;spage=25;epage=30;aulast=Stephensonhttp://www.annals.in/temp/AnnCardAnaesth13149-8041389_222013.pdf |
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