title: Myasthenia gravis: a careful perioperative anesthetic management of coronary artery bypass grafting.
abstract: Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis. We describe successful management without any pulmonary complications of two patients with myasthenia gravis undergoing coronary artery bypass grafting. In addition, antiacetylcholine receptor antibodies concentrations were evaluated during treatment time. In conclusion, we have found that reduced titrated doses of cisatracurium may be safely used in patients with myasthenia gravis undergoing cardiac surgery without anesthesia and respiratory-related complications.
authors.affiliation: Questions or comments about this article may be directed to Michał Kowalczyk, MD PhD, at michalkowalczyk@vp.pl. He is a Research Assistant and Specialist in Anesthesiology and Intensive Therapy, 1st Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland. Andrzej Nestorowicz, MD, is a Professor and Specialist in Anesthesiology and Intensive Therapy, Head of 1st Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland. Katarzyna Stachurska, MD, is an Assistant and Specialist in Anesthesiology and Intensive Therapy, 1st Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland. Anna Fijałkowska, PhD MD, is a Research Assistant and Specialist in Anesthesiology and Intensive Therapy, 1st Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland. Janusz Stążka, MD, is a Professor and Specialist in Cardiosurgery, Department of Cardiosurgery, Medical University of Lublin, Lublin, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Kowalczyk
authors.forename: Andrzej
authors.initials: A
authors.lastname: Nestorowicz
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Stachurska
authors.forename: Anna
authors.initials: A
authors.lastname: Fijałkowska
authors.forename: Janusz
authors.initials: J
authors.lastname: Stążka
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000451:nursing*; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives; D001026:Coronary Artery Bypass; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000451:nursing*; D009203:Myocardial Infarction / Q000451:nursing* / Q000601:surgery*; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage; D019990:Perioperative Care / Q000451:nursing*
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium