CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Froelich, J.
Right arrow Articles by Eagle, C. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Froelich, J.
Right arrow Articles by Eagle, C. J.

Canadian Journal of Anesthesia, Vol 43, 84-89, Copyright © 1996 by Canadian Anesthesiologists' Society

ARTICLES

Anaesthetic management of a patient with myasthenia gravis and tracheal stenosis

J Froelich and CJ Eagle
Department of Anaesthesia, Foothills Hospital, University of Calgary, Alberta.

PURPOSE: The combination of myasthenia gravis and tracheal obstruction presents a number of difficulties for anaesthetic management. This case illustrates the advantages of careful planning. CLINICAL FEATURES: A 66-yr-old man with myasthenia gravis required resection of a stenosis at the site of an old tracheostomy. The primary goal was to accomplish safe management of the airway, a task made more difficult because the airway was shared with the surgeon. Awake fibreoptic examination of the tracheal stenosis performed in the operating room provided useful information in planning the subsequent anaesthetic. From this examination, it was found that the trachea could be intubated by a normal endotracheal tube passed through the stenosis over the fibreoptic bronchoscope. Intraoperatively, the orotracheal tube was withdrawn temporarily and replaced with an endotracheal tube placed by the surgeon into the distal trachea. Extubation was carried out judiciously and a plan for reintubation prepared in advance. The anaesthetic plan was modified because of the myasthenia gravis. Following careful investigation of the extent of the patient's disease and its treatment, an assessment was made of the patient's need for postoperative ventilation. The anaesthetic plan included maintenance of anticholinergic medications until the time of surgery and their early resumption postoperatively, avoidance of neuromuscular blocking agents, and careful monitoring of neuromuscular function during the anaesthetic. CONCLUSION: Careful examination of the area of tracheal stenosis and a carefully considered plan for reintubation are prerequisites for this type of surgery. Clinically well controlled myasthenia gravis was managed successfully using familiar principles.


This article has been cited by other articles:


Home page
 Canadian J. AnesthesiaHome page
L. Vas, S. Sanzgiri, B. Patil, and V. Sanghvi
An unusual cause of tracheal stenosis
Can J Anesth, March 1, 2000; 47(3): 261 - 264.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1996 by the Canadian Anesthesiologists' Society.