VIII. Academic Studies Congress | Andizhan, Uzbekistan

Anesthesia Management in a Patient with Myasthenia Gravis Who Undergoes Achilles Tendon Rupture Repair- A Case Report

Not scheduled

20m

Description

İntroduction
Myasthenia Gravis (MG) is a chronic autoimmune disease. It is characterized by the production of autoantibodies against muscle-specific acetylcholine and tyrosine kinases. It usually presents with fatigue and skeletal muscle weakness that improve with rest. The response to anesthetic agents and respiratory complications of these patients are unpredictable. They are still challenging cases for anesthesiologists to manage. The aim of presenting this case is to keep the subject up-to-date for anesthesiologists and to contribute to the literature.
Case:
A 70-year-old female patient (height: 161 cm, weight: 73) was scheduled for surgery by the orthopedic clinic due to right Achilles tendon rupture. She was diagnosed with MG approximately 3 years ago due to complaints of ptosis and easy fatigue. The patient uses Pridostigmine and Olmesartan. In addition to standard monitoring, temperature monitoring was also performed. The patient underwent combined spinal-epidural anesthesia. Postoperative analgesia was provided with local anesthetics administered through the epidural catheter. She was transferred to our intensive care unit for one day for close monitoring. She was transferred to the ward 24 hours later. The epidural catheter was removed at the 72nd hour. The patient was discharged on the 5th day.
Dıscussıon/Conclusıon:
It is known that patients with MG respond differently to muscle relaxants. Spinal and epidural anesthesia are safely applied to these patients. However, there are studies indicating that patients with MG may also be sensitive to local anesthetics. Respiratory functions should also be closely monitored in patients who have received regional anesthesia. The level of sensory block should be monitored carefully and care should be taken to avoid sedation.
It is thought that pain accelerates myasthenic crisis in MG patients. Therefore, a postoperative analgesia plan is mandatory. These patients should not only be planned for standard monitoring. Especially if general anesthesia is planned, muscle junction monitoring with Train of Four (TOF) and temperature monitoring should also be performed. Extubation has always been a difficult situation for these patients. Therefore, regional anesthesia is preferred whenever possible.

In conclusion, despite the rapid advancement in technology, anesthesia management is still difficult for anesthesiologists in MG cases. Successful management requires careful and adequate preoperative evaluation, selection of appropriate anesthesia technique and meticulous perioperative monitoring.