Role of Intermittent Noninvasive Ventilation in Anticholinesterase Dose Adjustment for Myasthenic Crisis
| Autor: | Ravindra R Bhat, Sudeep Krishnappa, Sandeep Kumar Mishra, Ashok Shankar Badhe |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Mechanical ventilation
medicine.medical_specialty business.industry medicine.medical_treatment Respiratory arrest Neuromuscular transmission General Medicine medicine.disease Myasthenia gravis Surgery Anesthesiology and Pain Medicine Swallowing Pyridostigmine Anesthesia medicine Breathing Intubation medicine.symptom business medicine.drug |
| Zdroj: | Acta Anaesthesiologica Taiwanica. 48:53-54 |
| ISSN: | 1875-4597 |
| DOI: | 10.1016/s1875-4597(10)60012-4 |
| Popis: | A 27-year-old female was admitted with a history of speech and swallowing difficulties associated with ptosis for 6 months. There was progressive worsening of the symptoms with weakness that involved the facial and respiratory muscles. The patient had no significant concurrent illness. A provisional diagnosis of myasthenia gravis in crisis was made and confirmed by appropriate investigations. Computed tomography showed thymic enlargement. Trans-sternal thymectomy was done because prior plasmapheresis treatment with pyridostigmine, azathioprine and prednisolone was unsuccessful. The use of neuromuscular blockers with anesthesia was avoided to facilitate extubation at the end of the surgery in the absence of residual paralysis associated with muscle relaxants under neuromuscular transmission (NMT) monitoring. On postoperative day 3, the patient developed ptosis, breathing difficulties and respiratory arrest because the primary care physician had attempted to decrease the pyridostigmine dose, resulting in emergency intubation and mechanical ventilation. The pyridostigmine dose was gradually increased to 120 mg every 6 hours over 2 days. The patient’s condition steadily improved, allowing the withdrawal of ventilatory support and the patient was returned to a ward, with strict instructions regarding dosage and timing of the medications. The patient was readmitted the following week with respiratory difficulty, mild ptosis, and swallowing difficulties. It was found that the patient irregularly took her medications. The pyridostigmine dose was adjusted to 120 mg every 6 hours. Intermittent noninvasive ventilation (NIV) was also performed. It was observed that the patient regularly experienced intermittent breathing difficulties approximately 4 hours after each pyridostigmine dose. Thus, we provided intermittent NIV to maintain adequate and satisfactory ventilation and oxygenation during this transitional period (Figure 1), and thus avoid intubation. The pyridostigmine dose was further adjusted to 120 mg every 4 hours. Over the following 3 days the patient’s Role of Intermittent Noninvasive Ventilation in Anticholinesterase Dose Adjustment for Myasthenic Crisis |
| Databáze: | OpenAIRE |
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