Abstract
Thymoma, which can be surgically treated under general anesthesia, is associated with the pathophysiology of myasthenia gravis. Muscle weakness is a hallmark of myasthenia gravis; therefore, these patients are hypersensitive to the effects of nondepolarizing muscle relaxants. Neuromuscular blockers can cause prolonged postoperative muscle relaxation, leading to decreased respiratory function. Therefore, careful administration of muscle relaxants during the perioperative period is important. The neuromuscular antagonist, sugammadex, has been used to counteract problems associated with muscle relaxants. By encapsulating nondepolarizing muscle relaxants, sugammadex can reverse the neuromuscular blockade. Here we report three cases of myasthenia gravis. In each case, perioperative management included use of a train-of-four (TOF) monitor to minimize muscle relaxant use during surgery. Sugammadex was administered postoperatively, was safe for use in patients with myasthenia gravis, and may effectively reduce the risk of postoperative respiratory complications.
Highlights
Myasthenia gravis is an autoimmune disease for which muscle weakness is the primary symptom
Muscle weakness is caused by the blockade of neuromuscular transmission by antibodies against nicotinic acetylcholine receptors (AChRs), which are located in the post-synaptic membrane of the neuromuscular junction
We used a muscle relaxation monitor perioperatively in thymectomy cases complicated by myasthenia gravis
Summary
Myasthenia gravis is an autoimmune disease for which muscle weakness is the primary symptom. The prevalence of myasthenia gravis is increasing; approximately 20 in 100,000 people have the disease [1]. Its cause is unknown, myasthenia gravis may be a complication of thymoma. Symptoms of patients with myasthenia gravis often improve after thymectomy [2]. Many patients with myasthenia gravis undergo this procedure under general anesthesia. Patients with myasthenia gravis have intrinsic muscle weakness, the prolonged effects of residual muscle relaxants can lead to conditions such as respiratory failure [3]. The recently developed neuromuscular antagonist, sugammadex, encapsulates nondepolarizing neuromuscular blockers such as rocuronium and completely reverses the effects of muscle relaxants. We report on three patients with myasthenia gravis, whose postoperative progress was managed with sugammadex without complications
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