Nahara Isao, Takeuchi Masato, Yonekura Hiroshi, Takeda Chikashi, Kawakami Koji
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan.
BJA Open. 2022 Sep 23;4:100092. doi: 10.1016/j.bjao.2022.100092. eCollection 2022 Dec.
Using neuromuscular blocking drugs (NMBDs) for patients with myasthaenia gravis remains a challenge in perioperative management. Sugammadex has enabled the safe use of NMBDs. We investigated whether the adverse outcomes, and the treatment used for myasthaenic crises and tracheotomy, are affected by NMBD use in patients with myasthaenia gravis under general anaesthesia.
Patients with myasthaenia gravis who underwent general anaesthesia were retrieved from the Diagnostic Procedure Combination/Per-Diem Payment systems in Japan between 1 January 2010 and 30 November 2020. This database did not contain information on the severity of myasthaenia gravis (Osserman classification). Patients who received rocuronium and sugammadex were compared with those who did not receive NMBDs after propensity-score matching. We excluded patients who underwent emergency or cardiac surgery or tracheal intubation before anaesthesia. The primary outcome was receipt of postoperative treatment used for myasthaenic crises.
Among 2304 surgical patients with comorbid myasthaenia gravis, propensity-score matching identified 788 patients administered rocuronium and sugammadex and 449 not administered NMBDs. On comparing the treatment used for myasthaenic crises, we found no significant difference between the two groups (6.2% 5.3%; hazard ratio, 1.14; 95% confidence interval, 0.70-1.85).
Use of rocuronium and sugammadex in patients with myasthaenia gravis did not significantly affect the receipt of postoperative treatment used for myasthaenic crises compared with no use of NMBDs. As well as the severity of myasthaenia gravis was not fully adjusted, it is unclear whether intraoperative administration of rocuronium with the use of sugammadex postoperatively is acceptable and further investigations are needed.
对于重症肌无力患者，在围手术期管理中使用神经肌肉阻滞药物（NMBDs）仍然是一项挑战。舒更葡糖钠使得NMBDs能够安全使用。我们调查了在全身麻醉下，重症肌无力患者使用NMBDs是否会影响不良结局以及用于肌无力危象和气管切开术的治疗。
从2010年1月1日至2020年11月30日日本的诊断程序组合/每日支付系统中检索接受全身麻醉的重症肌无力患者。该数据库不包含重症肌无力严重程度（奥斯勒曼分类）的信息。在倾向评分匹配后，将接受罗库溴铵和舒更葡糖钠的患者与未接受NMBDs的患者进行比较。我们排除了在麻醉前接受急诊或心脏手术或气管插管的患者。主要结局是接受用于肌无力危象的术后治疗。
在2304例合并重症肌无力的手术患者中，倾向评分匹配确定了788例接受罗库溴铵和舒更葡糖钠的患者以及449例未接受NMBDs的患者。在比较用于肌无力危象的治疗时，我们发现两组之间没有显著差异（6.2%对5.3%；风险比，1.14；95%置信区间，0.70 - 1.85）。
与不使用NMBDs相比，重症肌无力患者使用罗库溴铵和舒更葡糖钠对接受用于肌无力危象的术后治疗没有显著影响。由于重症肌无力的严重程度没有得到充分调整，目前尚不清楚术中使用罗库溴铵并在术后使用舒更葡糖钠是否可接受，需要进一步研究。
