title: Anesthetic Management of a Patient With Antimuscle-Specific Kinase Antibody-Positive Myasthenia Gravis Undergoing an Open Cholecystectomy: A Case Report.
abstract: Myasthenia gravis (MG) is an autoimmune disease characterized by the production of antibodies against the acetylcholine receptor, muscle-specific kinase (MuSK), or other proteins at the neuromuscular junction. MG with antibodies against MuSK (MuSK-MG) has been described recently. Here, we report the first case of anesthetic management of a patient with MuSK-MG undergoing an open cholecystectomy. In our case, propofol and remifentanil-based anesthesia were used for successful management without using muscle relaxants. Patients with MuSK-MG have predominantly ocular, bulbar, and respiratory symptoms that may increase the risk of aspiration. Anesthesiologists need to pay attention to perioperative respiratory failure and respiratory crisis.
authors.affiliation: From the *Department of Anesthesiology, Iwaki Kyoritsu Hospital, Fukushima, Japan; †Department of Disaster and Comprehensive Medicine, Fukushima Medical University, Fukushima, Japan; ‡Department of Anesthesiology, Fukushima Medical University School of Medicine, Fukushima, Japan; and §Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Akatsu
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Ikegami
authors.forename: Choichiro
authors.initials: C
authors.lastname: Tase
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishikawa
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D001323:Autoantibodies / Q000276:immunology*; D002763:Cholecystectomy / Q000379:methods; D002764:Cholecystitis / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000276:immunology*; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D010880:Piperidines / Q000627:therapeutic use*; D015742:Propofol / Q000627:therapeutic use*; D020794:Receptor Protein-Tyrosine Kinases / Q000276:immunology*; D011950:Receptors, Cholinergic / Q000276:immunology*; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D001323:Autoantibodies; D010880:Piperidines; D011950:Receptors, Cholinergic; C095714:MUSK protein, human; D020794:Receptor Protein-Tyrosine Kinases; D000077208:Remifentanil; D015742:Propofol