ProSeal[TM] Laryngeal Mask Airway in a myasthenia gravis patient for thymectomy.
The ProSeal Laryngeal Mask Airway (PLMA) may be a satisfactory alternative to tracheal intubation for those patients with myasthenia gravis who do not require airway protection. However, use of the PLMA during thymectomy in myasthenic patients has not been reported previously. This report describes the use of a PLMA during thymectomy without the administration of muscle relaxant. A 68-year-old, 56 kg female with a thymoma measuring 2.3 x 1.8 x 2.7 cm and ocular myasthenia was scheduled for thymectomy. On the morning of the surgery, the patient had her usual dose of pyridostigmine. After induction of anaesthesia, a PLMA #4 was inserted. After confirming a satisfactory seal (up to 30 cm [H.sub.2]O) and the ability to ventilate the lungs manually, mechanical positive pressure ventilation was commenced using a tidal volume of 8 ml/kg. Anaesthesia was maintained using isoflurane and 50% nitrous oxide in oxygen. Both fentanyl and morphine were administered for analgesia. Surgical exposure for thymectomy was via a partial sternotomy wound. Both the anaesthesia and surgery were uneventful. At the end of the procedure, the patient was allowed to breathe 100% oxygen spontaneously. Once she was awake, the PIMA was removed.
This case indicates that the use of the PLMA may be a satisfactory alternative to tracheal intubation in patients with myasthenia gravis undergoing thymectomy (who do not require airway protection). The use of the PIMA may allow anaesthetists to avoid muscle relaxation completely in these patients.
N. C. HWANG
|Printer friendly Cite/link Email Feedback|
|Publication:||Anaesthesia and Intensive Care|
|Date:||Apr 1, 2007|
|Previous Article:||The use of ketamine as rescue analgesia in the recovery room following morphine administration--a double-blind randomised controlled trial in...|
|Next Article:||Anaesthesia for abdominal aneurysm repair in a patient with Guillain-Barre Syndrome.|