Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000600007
Brazilian Journal of Anesthesiology
Clinical Information

Miastenia gravis: relato de dois casos e revisão da literatura

Myasthenia gravis: two case reports and review of the literature

Ana Laura Colle Kauling; Maria Cristina Simões de Almeida; Giovani de Figueiredo Locks; Guilherme Muriano Brunharo

http://dx.doi.org/10.1590/S0034-70942011000600007 Braz J Anesthesiol, vol.61, n6, p.755-763, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A Miastenia gravis (MG) é uma doença neurológica autoimune que afeta a porção pós-sináptica da junção neuromuscular. Trata-se de um desafio ao anestesiologista, pela diversidade das manifestações da doença e pela possibilidade de complicações ventilatórias no pós-operatório. O objetivo deste trabalho é demonstrar a importância da monitoração adequada ao bloqueio neuromuscular (BNM) em virtude das múltiplas formas de apresentação da MG. CONTEÚDO: Neste artigo serão descritos dois casos de pacientes com MG - um que apresentou a forma clássica de sensibilidade ao bloqueador neuromuscular (BNM) e outro com resposta semelhante à de um paciente normal. A revisão da literatura será restrita às características da doença e a descrição de sua fisiopatologia estará voltada às reações aos BNM. CONCLUSÕES: Como conclusão, sugere-se que, em decorrência das múltiplas formas de apresentação e de tratamento da MG, é fundamental o uso de monitores da transmissão neuromuscular quando se usa BNM.

Palavras-chave

ANESTESIA, BLOQUEADOR MUSCULAR, DOENÇAS, DOENÇAS, MONITORAÇÃO, MONITORAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Myasthenia gravis (MG) is an autoimmune neurologic disease that affects the postsynaptic portion of the neuromuscular junction. It represents a challenge for anesthesiologists due to the diversity of disease manifestations and possibility of postoperative respiratory complications. The objective of this study was to demonstrate the importance of adequate monitoring of the neuromuscular blockade (NMB) due to the multiple presentations of MG. CONTENTS: In this paper we report two cases of patients with MG. The first patient presented with the classical sensitivity to the neuromuscular blocker (NMB) and the second had a similar response to that of a normal patient. The literature review will be restricted to disease characteristics, while the description of its pathophysiology will focus on its reactions to NMB. CONCLUSIONS: We suggest that, due to the multiple presentation and treatment of MG, neuromuscular transmission monitors are fundamental when using NMB.

Keywords

Neuromuscular Blocking Agents, Myasthenia gravis, Electromyography, Atracurium, Anesthesia, Monitoring

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