Mesh : Adult Anesthetics, Combined Anti-Inflammatory Agents / therapeutic use Drug Interactions Female Fentanyl Heart Valve Prosthesis Implantation / methods Humans Mitral Valve / surgery Mitral Valve Stenosis / complications surgery Myasthenia Gravis / complications drug therapy surgery Prednisone / therapeutic use Pyridostigmine Bromide / therapeutic use Sevoflurane Thymectomy

来  源:   DOI:10.1532/hsf.2627

Abstract:
Patients diagnosed with ocular myasthenia gravis (MG) and mitral valve disease represent a significant perioperative management problem, especially for the anaesthesiologist, due to complex inter-actions between the disease, drugs to treat the disease, and anaesthetic agents, such as neuromuscu-lar blocking agents (NMBAs). This paper describes the successful management of a 31-year-old female with mitral valve stenosis and ocular MG who was diagnosed with MG 4 years prior to the indication for cardiac surgery. Preoperatively, the patient was under treatment with Pyridostigmine and Prednisone. Mitral valve replacement and full thymectomy were performed, under general anaesthesia, using Fentanyl, Sevoflurane and low doses of non-depolarising NMBAs. The postoperative course was uneventful, the patient was extubated at 6 hours postoperatively, in-tensive care unit stay was 48 hours, and the patient was discharged after 6 days without any compli-cations. After 3 months, at the follow-up examination, the patient\'s ocular symptoms (eyelid ptosis) disappeared.
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