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Title:
Anestezija pri bolniku z miastenijo gravis
Authors:
ID
Mekiš, Dušan
(
Author
)
ID
Kamenik, Mirt
(
Author
)
Files:
http://www.medrazgl.si/e107_files/public/datoteke/mr03_2_04.pdf
Language:
Slovenian
Work type:
Not categorized
Typology:
1.02 - Review Article
Organization:
UM - University of Maribor
Abstract:
Miastenija gravis je avtoimunska bolezen motorične ploščice. Zmanjšanje števila funkcionalnih acetilholinskih receptorjev sovpada s težo klinične slike, ki se kaže z naraščajočo mišično utrujenostjo in slabljenjem mišične moči. Miastenijo gravis zdravimo tako, da izboljšamo živčno-mišični prenos z antiholinesteraznimi učinkovinami, zaviramo imunski sistem s kortikosteroidi in imunosupresivi ter zmanjšamo število protiteles v krvi s plazmaferezo. Miastenija gravis je pogosto povezana z morfološkimi spremembami priželjca. Odstranitev priželjca zmanjša potreben odmerek antiholinesterazne učinkovine in potrebo po imunosupresivnih zdravilih. V prispevku smo opisali posebnosti anestezije pri bolnikih z miastenijo gravis in prikazali primer vodenja anestezije za odstranitev priželjca skozi prsnico pri bolnici z miastenijo gravis. Pri bolnici smo anestezijo izvedli s kombinacijo visoke prsne epiduralne anestezije z 0,5% bupivacainom in fentanilom ter popolne intravenske anestezije s propofolom in remifentanilom. Naše izkušnje kažejo, da je kombinacija visoke prsne epiduralne anestezije in popolne intravenske splošne anestezije primerna anestezijska tehnika za odstranitev priželjca skozi prsnico. Omogoča stabilno delovanje obtočil med operacijo, varno odstranitev dihalne cevke po koncu operacije in učinkovito lajšanje bolečin po operaciji.
Year of publishing:
2003
Number of pages:
str. 155-163
Numbering:
Letn. 42, št. 2
PID:
20.500.12556/DKUM-56030
UDC:
616-089.5
ISSN on article:
0025-8121
COBISS.SI-ID:
1322559
NUK URN:
URN:SI:UM:DK:30KEBSIK
Publication date in DKUM:
21.12.2015
Views:
2099
Downloads:
61
Metadata:
Categories:
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Record is a part of a journal
Title:
Medicinski razgledi. [medicinski pregledni, strokovni in raziskovalni članki]
Shortened title:
Med. razgl.
Publisher:
Medicinski razgledi
ISSN:
0025-8121
COBISS.SI-ID:
3390978
Secondary language
Language:
English
Title:
Anaesthesia in patients with myasthenia gravis
Abstract:
Myasthenia gravis is an autoimmune disorder of the motor plate. The degree of reduction in the number of functional acetylcholine receptors correlates with the severity of myasthenia gravis as manifested by increasing weakness and fatigue of skeletal muscles. Medical treatment of myasthenia gravis includes improvement of neuromuscular transmission by anticholinesterases, suppression of the immune system with the use of corticosteroids and immunosuppressive drugs and reduction of the amount of circulating antibodies my plasmapheresis. Myasthenia gravis is frequently associated with an abnormality of the thymus. Transsternal thymectomy reduces the required doses of anticholinesterases and immunosuppressants. This paper presents the anesthetic management of patients with myasthenia gravis. The anesthetic management of a patient with myasthenia gravis undergoing transsternal thymectomy is also described. This patient received a combination of high thoracic epidural anaesthesia with 0,5% bupivacaine and fentanyl and total intravenous anaesthesia with propofol and remifentanyl. Our experience shows that a combination of high thoracic epidural anesthesia and total intravenous anesthesia is an appropriate anesthetic technique for transsternal thymectomy and ensures good hemodynamic stability during surgery, uneventful recovery and effective post-operative analgesia.
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