Gastric POCUS, 3-Part Episode
April 2024 OA-POCUS Case of the Month
Anesthesia Services in Tanzania and Kenya
OA-Global Health Equity Ask the Experts - April 2024
REPOST: October 2021 – Pediatric Tracheal Extubations
April 2024 OA-SPA Ask the Expert
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Question of the Day
A 52-year-old woman with myasthenia gravis presents for laparoscopic cholecystectomy under general anesthesia. Which of the following is MOST predictive of the need for postoperative mechanical ventilation in this patient?
Explanation
Myasthenia gravis is an autoimmune disease of the neuromuscular system. In myasthenia gravis there is autoantibody destruction of postsynaptic acetylcholine receptors. This leads to weakness and fatigue of skeletal muscles after exercise that usually improves with rest or with anticholinesterase medications. Patients with myasthenia gravis who undergo surgery and anesthesia are at higher risk for postoperative weakness and are exquisitely sensitive to nondepolarizing neuromuscular blockade. Criteria that increase the risk for postoperative mechanical ventilation in patients with myasthenia gravis (most of these indicate increased severity of disease) include: 1. Duration of disease >6 years 2. Vital capacity < 2.9 L (or < 40 mL/kg) 3. Presence of pulmonary disease (ex. COPD, Asthma) 4. Daily pyridostigmine dose >750 mg 5. Negative inspiratory force < 20 cm H2O
References:
Myasthenia Gravis Rudzka-Nowak A, Piechota M. Anaesthetic management of a patient with myasthenia gravis for abdominal surgery using sugammadex. Arch Med Sci. 2011;7(2):361-364. doi:10.5114/aoms.2011.22094 Eisenkraft JB, Papatestas AE, Kahn CH, Mora CT, Fagerstrom R, Genkins G. Predicting the need for postoperative mechanical ventilation in myasthenia gravis. Anesthesiology. 1986;65(1):79-82. doi:10.1097/00000542-198607000-00014 Rudzka-Nowak A, Piechota M. Anaesthetic management of a patient with myasthenia gravis for abdominal surgery using sugammadex. Arch Med Sci. 2011;7(2):361-364. doi:10.5114/aoms.2011.22094OA Series: April 2024
06:08
OA-POCUS Case of the Month
Gastric POCUS, Part 1 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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17:46
OA-POCUS Case of the Month
Gastric POCUS, Part 2 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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04:43
OA-POCUS Case of the Month
Gastric POCUS, Part 3 of 3Eric R. Heinz, MD, PhD, George Washington University, Yuriy Bronshteyn, MD, FASE, Duke University Health System
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41:04
OA Global Health Equity Ask the Expert
Anesthesia Services in Tanzania and KenyaSamuel Percy, MD, Children's Hospital Colorado
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16:40
OA-SPA Ask the Expert
REPOST: October 2021 – Pediatric Tracheal ExtubationsDebnath Chatterjee, MD, FAAP, Children’s Hospital Colorado
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