Elsharkawy Hesham A, Galway Ursula
Department of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Case Rep Anesthesiol. 2012;2012:217561. doi: 10.1155/2012/217561. Epub 2012 Feb 2.
We describe the anesthetic management of a patient with severe myasthenia gravis and tracheal stenosis; the patient was scheduled for direct laryngoscopy and dilatation. The combination of myasthenia gravis and tracheal obstruction presents several difficulties for anesthetic management. The airway is shared; therefore, any complications are also shared by the anesthesiologist and bronchoscopists. The potential for respiratory compromise in patients undergoing the two procedures requires that anesthesiologists be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs in a case involving myasthenia gravis. We reviewed the literature and report our experience in this case. There is no strong evidence for choosing one approach to general anesthesia over another for bronchoscopy. Careful preoperative planning and experience in airway management and jet ventilation are crucial to prevent an adverse outcome and obtain favorable results.
我们描述了一名患有严重重症肌无力和气管狭窄患者的麻醉管理；该患者计划接受直接喉镜检查和扩张术。重症肌无力和气管阻塞的合并症给麻醉管理带来了诸多困难。气道是共用的；因此，麻醉医生和支气管镜检查医生也都会面临任何并发症。接受这两种手术的患者存在呼吸功能受损的可能性，这就要求麻醉医生熟悉潜在的疾病状态，以及在涉及重症肌无力的病例中麻醉药物和非麻醉药物之间的相互作用。我们查阅了文献并报告了该病例的经验。对于支气管镜检查，没有强有力的证据支持选择一种全身麻醉方法优于另一种。仔细的术前规划以及气道管理和喷射通气方面的经验对于预防不良后果并取得良好效果至关重要。
