MedEdPORTAL (Jan 2012)
Anesthetic Management of Myasthenia Gravis: COPD and Asthma Patient
Abstract
Abstract Introduction Conduction of general anesthesia and perioperative management of the patients with compromised lung functions and myasthenia gravis, presented for major abdominal surgery, poses a number of problems. These problems include: intraoperative management of and postoperative weaning from mechanical ventilation, pharmacology of muscle relaxants and their reversal in the presence of myasthenia gravis, postoperative pain management, and more. Methods The purpose of this problem-based learning discussion is to provide educational materials for problem-based learning discussion (PBLD) of important aspects of anesthesia and perioperative management of the medically challenging, complicated case, presented for major abdominal surgery. The case itself is similar (but not identical) to a real one managed by author as an anesthesia attending, with active participation of two anesthesia residents. The pre- and postanesthesia discussions of the real case with the residents have created the basis for this PBLD. Results The presented material has been successfully used during the PBLD sessions in several occasions. After completion of the session, medical students and, especially, anesthesia residents provided a very positive feedback in respect to the content, style, and level of discussion. Medical students emphasized that they have acquired a great deal of knowledge and practical skills in planning and management of anesthesia of the medically challenging patients. Comprehensiveness and high informational load and resemblance to the actual oral boards format-vignette of the presented material was also highly appreciated by anesthesia residents. Discussion There are several limitations of the presented resource. Arterial blood gases interpretation pertinent for the case, intraoperative fluid management and possible blood products transfusion, management of postoperative ventilation, options of postoperative pain control, immediate and long-term respiratory complications have not been discussed. Inclusion of these topics and perhaps also the possibility of difficult airway management in this patient in the discussion would considerably expand the scope of the discussion, potentially making it stronger.
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