Faculty of Medicine
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Item type:Publication, Transient Neonatal Myasthenia Gravis: A Case Report(Macedonian Academy of Science and Arts/Sciendo, 2023-07-15); Renata DimitrioskaTransient neonatal myasthenia gravis (TNMG) is a neuromuscular disorder that occurs in infants born from mothers with myasthenia gravis (MG) due to transplacental transfer of antibodies against the acetylcholine receptor. TNMG is a rare form occurring in 10-15% of infants born from mothers with MG. We present a case of a newborn with TNMG with generalized hypotonia and respiratory distress. The newborn shows symptoms of hypotonia, weakened reflexes, poor crying, difficult sucking and potentiated tachydyspnea after 24 hours of birth and needs of assisted mechanical ventilation. Based on the mother's positive history of MG and the high titer of mother's (8.43nmol/l) and newborn's (9.088nmol/l) anti-AChR antibodies, TNMG was diagnosed. The baby was treated with assisted mechanical ventilation and neostig-mine until the anti-AChR antibody titer was negative. Adequate management of the newborn resulted in a positive outcome and evident withdrawal of the symptoms. Although TNMG is one of the rare neuromuscular disorders in newborns that can be treated, a multidisciplinary approach in the management of pregnant women with MG and newborns through timely diagnosis and early appropriate treatment, results in successful resolution of this condition. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ANKLE BLOCK AN ALTERNATIVE OF ANESTHETIC MANAGEMENT OF MYASTHENIA GRAVIS (CASE REPORT)(Department of Anesthesia and Reanimation, Faculty of Medicine, Ss.Cyril and Methodius University, Skopje Macedonia, 2018-12); ; ; Myasthenia gravis (MG) is a chronic autoimmune disease characterized by a decrease in acetylcholine receptors at the neuromuscular junction, secondary to destruction or inactivation by circulating antibodies. In patients with MG, perioperative issues remain unclear, especially the use of regional anesthetic techniques, while the perioperative and postoperative complications are numerous. Preoperative evaluation is crucial for choosing the modality. CASE REPORT: A 52 years old female patient with 16 years history of myasthenia gravis was admitted for Lisfranc amputation. Preoperative examination was made, and many comorbidities were noted (Myocardial infarction with stenting, CVI, Diabetes mellitus type II, many respiratory infections). The severity was estimated by Osserman classification as type III B, a severe stadium with ptosis, respiratory dysfunction and generalized weakness. According to all preoperative evaluations, treatment regiment and in collaboration with the surgeon, it was decided to apply regional anesthesia. Ankle block was administered, with 25 ml 0.5% Bupivacaine. Good perioperative analgesia was provided. DISCUSSION AND CONCLUSION: The potential for respiratory compromise in patients with myasthenia gravis requires the anesthesiologist to be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs. When possible, regional anesthetic techniques are preferred by many anesthesiologists. Ester anesthetics, which are metabolized by cholinesterase, may present particular problems in patients taking anticholinesterases. That’s why regional and local anesthesia should be performed using reduced doses of amide (rather than ester) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Myasthenia gravis and general anesthesia(Department of Anesthesia and reanimation, Faculty of Medicine, Ss.Cyril and Methodius University, Skopje, Macedonia, 2017-04); ; ; Myasthenia gravis patients undergoing general anesthesia are real challenge. Several contemporary issues of the disease, as well as the therapy and additional contributing factors interfere with the anesthetics on several levels. Up to day, literature has not proved which type of anesthesia or anesthetics are superior in such patients. The aim of this article is to elaborate and review some of the possible aspects of this disease and their interference with anesthesia that have direct influence on these patients outcome.