SPECIFIC MANAGEMENT OF MYASTHENIA GRAVIS IN PATIENTS UNDERGOING ABDOMINAL CANCER SURGERIES

Abstract

21 clinical cases of abdominal cancer surgery in patients with concomitant myasthenia gravis are combined with the use of the “pharmacological duet” of rocuronium ‒ sugammadex and the mandatory monitoring of neuromuscular conduction. In all cases, surgery procedures were performed under combined anesthesia with sevoflurane and low-dose epidural ropivacaine + fentanyl + norepinephrine. In all cases, except one, when the mechanical ventilation was planned and determined by the severity of the operation, blood loss and hypothermia, it was possible to reliably restore the spontaneous breathing immediately after the end of the operation. The necessity of an individual approach to patients suffering from myasthenia gravis, due to the difference in its severity and degree of compensation, is clearly shown. It was especially emphasized that with subcompensated state, incomplete efficacy of sugammadex is possible and additional intravenous administration of anticholinesterase drugs may be required (2 cases). In addition, in severe myasthenia gravis, a discrepancy is possible between “safe” TOF = 90% and clinical signs of residual respiratory failure (1 case).

Keywords

• myasthenia gravis
• abdominal and thoracic surgery
• rocuronium
• sugammadex
• tof monitoring
• anticholinesterase drugs