Spasojevic Ivana, Hajdukovic Danica, Komarcevic Milena, Petrovic Stanislava, Jovanovic Jelena, Ciric Aleksandra
Med Pregl. 2016 Sep;69(9-10):305-311. doi: 10.2298/mpns1610305s.
Myasthenia gravis is an autoimmune disease caused by antibodies leading to the destruction of nicotinic acetylcholine receptors on the neuromuscular junction. It is characterized by muscle weakness that gets aggravated with physical activity and improves at rest. Myasthenia Gravis Foundation of America made the clinical classification of Myasthenia gravis which is still in use today. "Tensilon test" is still the gold standard for the diagnosis of Myasthenia gravis. In addition to this test repeated muscular stimulation can be used as well as the analysis of specific autoantibodies. Treatment of Myasthenia Gravis. In conservative treatment of Mysthenia gravis anticholinesterases, immunosuppressants and plasmapheresis can be used. If conservative treatment does not lead to the desired remission, surgical treatment is indicated. The most accepted indication for thymectomy is the presence of thymoma with generalized form of Myasthenia gravis in adults. How to Distinguish Myasthenic From Cholinergic Crisis.'The following is important to make a difference between these two crises: knowledge of the events that preceded the crisis, the size of pupils as well as the presence of muscarinic signs and tensilon test. Specific Features of Anesthesia in Patients with Myasthienia Gravis. Mechanism of the disease development is the reason'for the increased sensitivity or resistance of these patients to certain types of drugs used in anesthesia. Protocol of Perioperative Anesthesia in Patients with Myasthenia Gravis. Based on 35 years of experience in the surgical treatment of patients with Myasthenia gravis anesthesiologists at the Department of Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina. made the protocol of anesthesia and perioperative treatment for these patients.
Anesthesiologists may have to deal with a patient with myasthenia gravis in different types of surgical interventions. The protocol for anesthesia and perioperative management of these patients herewith presented may greatly help them in their clinical practice.
重症肌无力是一种自身免疫性疾病，由抗体导致神经肌肉接头处烟碱型乙酰胆碱受体被破坏。其特征为肌肉无力，体力活动时加重，休息时改善。美国重症肌无力基金会制定了重症肌无力的临床分类，至今仍在使用。“腾喜龙试验”仍是诊断重症肌无力的金标准。除此之外，重复肌肉刺激以及特定自身抗体分析也可用于诊断。重症肌无力的治疗。在重症肌无力的保守治疗中，可使用抗胆碱酯酶药物、免疫抑制剂和血浆置换。如果保守治疗未能达到预期缓解效果，则需进行手术治疗。胸腺切除术最公认的指征是成人重症肌无力全身型合并胸腺瘤。如何区分肌无力危象和胆碱能危象。以下内容对于区分这两种危象很重要：了解危象发生前的事件、瞳孔大小以及是否存在毒蕈碱样体征和腾喜龙试验结果。重症肌无力患者麻醉的特殊特征。疾病发展机制是这些患者对麻醉中使用的某些类型药物敏感性增加或产生耐药性的原因。重症肌无力患者围手术期麻醉方案。基于伏伊伏丁那肺病研究所胸外科对重症肌无力患者进行外科治疗35年的经验，该科室的麻醉医生制定了这些患者的麻醉和围手术期治疗方案。
麻醉医生可能会在不同类型的外科手术中遇到重症肌无力患者。本文所呈现的这些患者的麻醉和围手术期管理方案可能会在他们的临床实践中给予极大帮助。
