Precautions for surgery in patients with myasthenia gravis
As it is a rare disease, Many hospitals have to ask neurology consultation to determine the surgical indications and anesthesia methods after surgical treatment of myasthenia gravis patients with patients requiring surgery. In fact, the basic principle of clinical medicine is to [solve the main contradiction at present], If the patient’s surgery is imminent, Such as intestinal obstruction or spleen rupture, No matter what happened to the previous myasthenia gravis, emergency surgery is required. Even if the operation will aggravate myasthenia gravis, there is no need to worry about it. Because if the current surgical situation is not handled in time, it will endanger life. Therefore, emergency surgery for myasthenia gravis patients mainly refers to the surgical indications of the surgery itself, As for the condition of myasthenia gravis, we can only take one step at a time. If the operation itself is an elective operation, the condition of myasthenia gravis of the patient should be fully considered. If the condition is unstable (type IIB or crisis), it should be postponed until the condition is stable, such as hysteromyoma or thymoma.
Some drugs used during the perioperative period may worsen the condition of myasthenia gravis. In the selection of anesthesia, General local anesthesia or spinal anesthesia is better than general anesthesia. Ganglion muscle junction blockers should be used with caution selectively. The required dose of depolarizing muscle relaxant (such as Sikolin) may be higher than that of non-myasthenia gravis patients, but non-depolarizing muscle relaxant (such as Vancasone) can cause obvious and long-lasting blocking effect with only a lower dose, and the required auxiliary breathing time after operation is also prolonged. Therefore, depolarizing muscle relaxant (such as Sikolin) is recommended for myasthenia gravis patients.
Epidural anesthesia is safer
Some myasthenia gravis patients may need epidural anesthesia for caesarean section, hysteromyoma, lower limb surgery and other reasons in their lifetime. Many patients will come to the outpatient department to consult related issues. Some surgeons and patients will [lose color] when they hear of myasthenia gravis, fearing that anesthesia will aggravate the disease and cause crisis, making it difficult for myasthenia gravis to seek medical treatment due to surgical problems.
Epidural anesthesia is the injection of local anesthetic into the epidural space, Block spinal nerve root, temporarily paralyze its innervation area, called epidural space block anesthesia, abbreviated as epidural block. Local anesthetic drugs are generally lidocaine, bupivacaine and other mixed with epinephrine, mainly acting in subarachnoid space, will not directly affect the transmission of neuromuscular junction.
In the past, some people thought that epidural anesthesia may affect patients’ respiratory function, This increases the risk of respiratory failure after surgery. However, subsequent studies have shown that this is not the case. Epidural anesthesia has achieved great success in childbirth for myasthenia gravis patients. Epidural anesthesia can not only reduce the use of other anesthetic drugs during surgery, but also reduce the use of opioid drugs after surgery.
Therefore, if myasthenia gravis patients need to undergo epidural anesthesia surgery due to their illness, they do not need to look ahead and look back. Doctors should explain to patients from a professional perspective to reduce the psychological burden of patients and their families. At the same time, it is necessary to pass on the concept of [epidural anesthesia is safer] to surgical colleagues so that the relevant operations of patients can be carried out in a timely and smooth manner.
Author: Huashan myopathy group
The article was reprinted by Clove Garden authorized by the author.