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ProSeal[TM] Laryngeal Mask Airway in a myasthenia gravis patient for thymectomy.

In myasthenia gravis, formation of antibodies against the acetylcholine receptor at the neuromuscular junction results in muscle weakness. Patients with myasthenia gravis may require thymectomy. In most cases, patients undergoing thymectomy require tracheal intubation for airway protection and positive pressure ventilation. However, achieving satisfactory intubating conditions often requires the use of a muscle relaxant, which may be problematic in myasthenic patients.

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.


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Title Annotation:Correspondence
Author:Hwang, N.C.
Publication:Anaesthesia and Intensive Care
Geographic Code:9SING
Date:Apr 1, 2007
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