Anesthesia Management in a Patient with Myasthenia Gravis Who Underwent Aortic Valve Replacement Surgery

Abstract

General anesthesia was planned for aortic valve replacement in a 67-year-old patient with type IIa myasthenia gravis (MG) who was on pyridostigmine treatment for 18 months. Pyridostigmine treatment was continued until the morning of the surgery. Propofol, fentanyl, and rocuronium were administered for the induction of anesthesia and sevoflurane for maintaining the surgery. The surgery was performed using standard sternotomy and under antegrade hypothermic blood cardioplegia for cardiopulmonary bypass. The cardiopulmonary bypass was uneventful. At the end of the surgery, remifentanil infusion was discontinued; the patient was transferred to the intensive care unit of cardiovascular surgery and was intubated. At 8 h postoperatively, the patient, after meeting the criteria for extubation, was extubated. No problem occurred during the follow-up. The patient was discharged on postoperative day 5 without any complications. In conclusion, open heart surgery accompanied by cardiopulmonary bypass can be safely performed in patients with MG by careful preoperative evaluation and postoperative follow-up, administration of muscle relaxant in reduced doses, and continuation of treatment with anticholinesterase inhibitors.

Özet

Altmış yedi yaşında, 18 aydır pridostigmin tedavisi alan tip IIa myasthenia gravisli (MG) hastaya aort kapak replasmanı için genel anestezi planlandı. Piridostigmin tedavisine ameliyat sabahı devam edildi. Anestezi indüksiyonunda propofol, fentanil ve rokuronyum, idamede sevofluran kullanıldı. Operasyon standart sternotomi ve heparinizasyonu takiben kardiyopulmoner baypasta antegrad hipotermik kan kardiyoplejisiyle gerçekleştirildi. Kardiyopulmoner baypastan sorunsuz çıkıldı. Operasyon bitiminde remifentanil infüzyonu kesildi, hasta entübe şekilde kardiyovasküler cerrahi yoğun bakım ünitesine transfer edildi. Postoperatif 8. saatte ekstübasyon kriterleri sağlandıktan sonra ekstübe edildi. Takip dönemi sorunsuzdu. Hasta postoperatif 5. gün komplikasyonsuz olarak taburcu edildi. Sonuç olarak MG’li hastalarda dikkatli bir preoperatif değerlendirme ve postoperatif takip, azaltılmış dozlarda kas gevşetici kullanımı ve antikolinesteraz tedaviye devam edilmesi ile kardiyopulmoner baypas eşliğinde açık kalp cerrahisi güvenle uygulanabilir.