is associate dean, Academic Affairs and Graduate Nursing, Loma Linda University, Loma Linda, California.
is a staff anesthetist in Albuquerque, New Mexico.
AANA J. 2020 Dec;88(6):485-491.
Patients with neuromuscular diseases such as myasthenia gravis can present as complicated anesthetic cases. This article reviews anesthetic considerations for optimal perioperative care of patients with myasthenia gravis. The pathophysiology of myasthenia gravis, cholinergic and myasthenic crises, and perioperative management are discussed; this includes the pharmacology of acetylcholinesterase inhibitors vs sugammadex, extubation criteria, pain management, and risk factors for postoperative myasthenic crisis. Anesthesia recommendations include reversal of nondepolarizing neuromuscular blockade agents with sugammadex, obtaining sufficient spontaneous breathing with absolutely no residual curarization before extubation, limited use of opioids and sedatives, avoidance of routine admission to the intensive care unit, and consideration of peripheral nerve blocks for adjunct pain control.
患有重症肌无力等神经肌肉疾病的患者可能会出现复杂的麻醉情况。本文回顾了重症肌无力患者围手术期最佳护理的麻醉注意事项。讨论了重症肌无力的病理生理学、胆碱能危象和肌无力危象以及围手术期管理；包括乙酰胆碱酯酶抑制剂与 sugammadex 的药理学、拔管标准、疼痛管理以及术后肌无力危象的危险因素。麻醉建议包括使用 sugammadex 逆转非去极化神经肌肉阻滞药、在拔管前获得绝对无残留肌松作用的充分自主呼吸、限制使用阿片类药物和镇静剂、避免常规入住重症监护病房以及考虑外周神经阻滞作为辅助止痛控制。
