Staikou Chryssoula, Rekatsina Martina
Department of Anesthesiology, Aretaieio Hospital, Medical School, National and Kapodistrian, University of Athens, Athens, Greece.
Saudi J Anaesth. 2017 Oct-Dec;11(4):472-475. doi: 10.4103/sja.SJA_625_16.
Multiple sclerosis (MS) is a potentially disabling disease characterized by demyelinating lesions in the central nervous system. One of the anesthetic challenges encountered in surgical patients with MS is the management of neuromuscular blockade (NMB) and its reversal. We report a case of a 31-year-old female patient suffering from MS, who underwent gynecological surgery under general anesthesia with sevoflurane, fentanyl, and rocuronium which was successfully reversed with sugammadex. Neuromuscular transmission (NMT) monitoring was used to guide the intraoperative doses of rocuronium and also the reversal of NMB by the use of sugammadex to ensure a safe tracheal extubation. In addition, delivered volatile was titrated according to anesthetic depth monitoring (Bispectral Index) while esophageal temperature was also monitored for the maintenance of normothermia. Postoperatively, a multimodal analgesic scheme offered a high-quality analgesia and sleep, minimization of anxiety, and increased patient satisfaction. At 1-month follow-up, the patient's course was uncomplicated without any MS exacerbation. We consider that the use of rocuronium and sugammadex under NMT monitoring may represent a useful and safe choice in patients with MS.
多发性硬化症（MS）是一种潜在的致残性疾病，其特征是中枢神经系统出现脱髓鞘病变。患有MS的外科手术患者面临的麻醉挑战之一是神经肌肉阻滞（NMB）的管理及其逆转。我们报告了一例31岁患有MS的女性患者，她在全身麻醉下使用七氟醚、芬太尼和罗库溴铵进行了妇科手术，并用舒更葡糖成功逆转了神经肌肉阻滞。神经肌肉传递（NMT）监测用于指导术中罗库溴铵的剂量以及使用舒更葡糖逆转神经肌肉阻滞，以确保安全的气管拔管。此外，根据麻醉深度监测（脑电双频指数）滴定吸入的挥发性麻醉药，同时监测食管温度以维持正常体温。术后，多模式镇痛方案提供了高质量的镇痛和睡眠，将焦虑降至最低，并提高了患者满意度。在1个月的随访中，患者病程顺利，没有任何MS病情加重的情况。我们认为，在NMT监测下使用罗库溴铵和舒更葡糖可能是MS患者有用且安全的选择。
