[Fastrach laryngeal mask, sevoflurane and remifentanil: an anesthetic alternative for the myasthenic patient].
A 46-year-old myasthenic man diagnosed two months earlier and experiencing nocturnal dyspnea was scheduled for transsternal thymectomy. The patient was premedicated with midazolam in the operating room. Anesthetic induction and maintenance were with inhaled sevoflurane and an intravenous infusion of remifentanil, with no need for neuromuscular relaxants. Airway management was achieved by inserting a Fastrach laryngeal mask (LM-Fastrach), through which an endotracheal tube could be inserted easily. The tube was withdrawn through the mask at the end of surgery and the mask was removed in the operating room 6 minutes later. Anesthesia in patients with myasthenia gravis is one of the greatest challenges in clinical anesthesiology. The interest of this case lies mainly in that the anesthetic technique chosen allows neuromuscular relaxants to be avoided. Moreover, airway access through the Fastrach laryngeal mask is highly useful for transsternal thymectomy of the patient with myasthenia gravis, providing immobility and adequate hemodynamic stability during sternotomy as well as facilitating safe and rapid postanesthetic recovery.
Servicio de Anestesiología, Reanimación y Terapia del Dolor y, Hospital General Universitario, Valencia. manuelgranell@telelineb
M
M
Granell Gil
R
R
García Aguado
L
L
Ferrándiz Roca
A
A
Arnau Obrer
A
A
Cantó Armengod
F
F
Grau Real
J M
JM
Palanca Sanfrancisco
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D010880:Piperidines; D000077208:Remifentanil; D000077149:Sevoflurane; D013934:Thymectomy / Q000379:methods*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil