title: [Desflurane anesthesia without muscle relaxant for a patient with myasthenia gravis undergoing laparoscopic high anterior resection: a case report].
abstract: Myasthenia gravis (MG) is an autoimmune disease affecting neuromuscular junction, which is characterized by fluctuating muscle weakness and abnormal fatigability. The use of muscle relaxants is major concern in anesthetic management for patients with MG. Muscle relaxant is a practical tool to assure immobilization during surgery under general anesthesia Anesthetic management without muscle relaxants for patients with MG is challenging, because it is difficult to assure immobilization. However, pharmacological effects of muscle relaxants can be prolonged in patients with MG, resulting in the increased incidence of postoperative respiratory support. We, here, describe an anesthetic management of an 82-year-old man with MG undergoing laparoscopic surgery. Anesthesia was induced with propofol and remifentanil Desflurane was administered via a face mask, and the patient was manually ventilated for 10 min, and the trachea was intubated safely without muscle relaxants. Anesthesia was maintained with desflurane and remifentanil. We did not administer muscle relaxants to the patient during surgery. Throughout laparoscopic procedures, no movements of the patient were observed, and there were no problems concerning the laparoscopic view of the operation filed. The surgery was uneventful. The patient emerged from anesthesia smoothly, and was extubated safely. The postoperative course of the patient was also uneventful.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Koda
authors.forename: Haruka
authors.initials: H
authors.lastname: Kimura
authors.forename: Masashi
authors.initials: M
authors.lastname: Uzawa
authors.forename: Norie
authors.initials: N
authors.lastname: Sambe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Sugano
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kitamura
authors.forename: Megumi
authors.initials: M
authors.lastname: Tagami
mesh_terms: D000369:Aged, 80 and over; D000768:Anesthesia, General; D000075202:Contraindications; D000077335:Desflurane; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009157:Myasthenia Gravis / Q000150:complications*; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D012004:Rectal Neoplasms / Q000601:surgery*; D000077208:Remifentanil
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil