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Anaesthetic management of myasthenia gravis in coronary artery bypass grafting


1 Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre and University of Manchester, Manchester, United Kingdom
2 Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre and University of Manchester, Manchester, United Kingdom; Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany; Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Australia

Correspondence Address:
Marc O Maybauer
Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_176_18

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Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 209-211

 

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Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction causing weakness and fatigability of muscles. Careful perioperative management is required because of the unpredictable susceptibility to muscle relaxants. In this case report, we describe the successful management of a MG patient for normothermic coronary artery bypass graft (CABG) surgery with titrated doses of rocuronium without prolonged postoperative ventilation. We chose rocuronium because full and rapid recovery of neuromuscular blockade is possible with sugammadex. We conclude that using rocuronium is safe during general anaesthesia in MG patients undergoing on-pump CABG when combined with continuous neuromuscular monitoring and careful perioperative management.






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1 Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre and University of Manchester, Manchester, United Kingdom
2 Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre and University of Manchester, Manchester, United Kingdom; Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany; Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Australia

Correspondence Address:
Marc O Maybauer
Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_176_18

Rights and Permissions

Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction causing weakness and fatigability of muscles. Careful perioperative management is required because of the unpredictable susceptibility to muscle relaxants. In this case report, we describe the successful management of a MG patient for normothermic coronary artery bypass graft (CABG) surgery with titrated doses of rocuronium without prolonged postoperative ventilation. We chose rocuronium because full and rapid recovery of neuromuscular blockade is possible with sugammadex. We conclude that using rocuronium is safe during general anaesthesia in MG patients undergoing on-pump CABG when combined with continuous neuromuscular monitoring and careful perioperative management.






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