Author/Editor		Mekiš, Dušan; Kamenik, Mirt
Title		Anestezija pri bolniku z miastenijo gravis
Translated title		Anesthesia in patients with myasthenia gravis
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 42, št. 2
Publication year		2003
Volume		str. 155-63
Language		slo
Abstract		Myasthenia gravis is an autoimmune disorder of the motor plate. The degree of reduction in the number of functional acetylcholine receptors correlates with the severity of myasthenia gravis as manifested by increasing weakness and fatigue of skeletal muscles. Medical treatment of myasthenia gravis includes improvement of neuromuscular transmission by anticholinesterases, suppression of the immune system with the use of corticosteroids and immunosuppressive drugs and reduction of the amount of circulating antibodies by plasmapheresis. Myasthenia gravis is frequendy associated with an abnormality of the thymus. Transsternal thymectomy reduces the required doses of anticholinesterases and immunosuppressants. This paper presents the anesthetic management of patients with myasthenia gravis. The anesthetic management of a patient with myasthenia gravis undergoing transsternal thymectomy is also described. This patient received a combination of high thoracic epidural anaesthesia with 0,5% bupivacaine and fentanyl and total intravenous anaesthesia with propofol and remifentanyl. Our experience shows that a combination of high thoracic epidural anesthesia and total intravenous anesthesia is an appropriate anesthetic technique for transsternal thymectomy and ensures good hemodynamic stability during surgery, uneventful recovery and effective post-operative analgesia.
Summary		Miastenija gravis je avtoimunska bolezen motorične ploščice. Zmanjšanje števila funkcionalnih acetilholinskih receptorjev sovpada s težo klinične slike, ki se kaže z naraščajočo mišično utujenostjo in slabljenjem mišične moči. Miastenijo gravis zdravimo tako, da izboljšamo živčno-mišični prenos z antiholinesteraznimi učinkovinami, zaviramo imunski sistem s kortikosteroidi in imunosupresivi ter zmanjšamo število protiteles v krvi s plazmaferezo. Miastenija gravis je pogosto povezana z morfološkimi spremembami priželjca. Odstranitev priželjca zmanjša potreben odmerek antiholinesterazne učinkovine in potrebo po imunosupresivnih zdravilih. V prispevku smo opisali posebnosti anestezije pri bolnikih z miastenijo gravis in prikazali primer vodenja anestezije za odstranitev priželjca skozi prsnico pri bolnici z miastenijo gravis. Pri bolnici smo anestezijo izvedli s kombinacijo visoke prsne epiduralne anestezije z 0,5% bupivacainom in fentanilom ter popolne intravenske anestezije s propofolom in remifentanilom. Naše izkušnje kažejo, da je kombinacija visoke prsne epiduralne anestezije in popolne intravenske splošne anestezije primerna anestezijska tehnika za odstranitev priželjca skozi prsnico. Omogoča stabilno delovanje obtočil med operacijo, varno odstranitev dihalne cevke po koncu operacije in učinkovito lajšanje bolečin po operaciji.
Descriptors		MYASTHENIA GRAVIS THYMECTOMY CHOLINESTERASE INHIBITORS IMMUNOSUPPRESSIVE AGENTS PREMEDICATION ANESTHESIA, EPIDURAL ANESTHESIA, INTRAVENOUS