Uchida Satoshi, Kudo Reiko, Takekawa Daiki, Hirota Kazuyoshi
Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
JA Clin Rep. 2022 Jul 15;8(1):49. doi: 10.1186/s40981-022-00541-4.
Some individuals with subclinical myasthenia gravis (MG) are positive for serum anti-acetylcholine receptor antibodies, without neurological symptoms. There are no anesthetic management guidelines for subclinical MG. We report the anesthetic management of a patient with subclinical MG who underwent a thymectomy.
A 57-year-old female with subclinical MG was scheduled for an extended thymectomy. Anesthesia was induced and maintained with mainly propofol and remifentanil. We administrated the minimum amount of rocuronium with reference to train-of-four (TOF) monitoring when a neuromuscular relaxant is needed. Although the prolonged effect of rocuronium was observed, the TOF ratio had already recovered to 100% before the tracheal extubation. Postoperative analgesia was performed by a continuous epidural infusion of levobupivacaine.
We reported the anesthetic management of a patient with subclinical MG who underwent a thymectomy. Further research is necessary to clarify subclinical MG patients' sensitivity to rocuronium.
一些亚临床型重症肌无力（MG）患者血清抗乙酰胆碱受体抗体呈阳性，但无神经症状。目前尚无亚临床型MG的麻醉管理指南。我们报告了1例接受胸腺切除术的亚临床型MG患者的麻醉管理情况。
1例57岁亚临床型MG女性患者计划接受扩大胸腺切除术。麻醉诱导和维持主要使用丙泊酚和瑞芬太尼。在需要使用神经肌肉阻滞剂时，我们参照四个成串刺激（TOF）监测给予最小剂量的罗库溴铵。尽管观察到罗库溴铵作用时间延长，但气管拔管前TOF比值已恢复至100%。术后镇痛采用连续硬膜外输注左布比卡因。
我们报告了1例接受胸腺切除术的亚临床型MG患者的麻醉管理情况。有必要进一步研究以明确亚临床型MG患者对罗库溴铵的敏感性。
