Airton Bagatini

Patients with neuromuscular diseases, as Myasthenia Gravis, react abnormally to anesthetics, depending on the technique and on the drugs. This report aimed at showing a case of Myasthenia Gravis patient submitted to thymectomy under total intravenous anesthesia with propofol and remifentanil. Female Myasthenia Gravis patient, 52 years old, 72 kg, submitted to transternal thymectomy, under total intravenous anesthesia with propofol in target controlled infusion (3 microg.ml-1) and continuous remifentanil (0.3 microg.kg-1.min-1). Succinylcholine (50 mg) was used for tracheal intubation, which was achieved without difficulty. Tramadol (50 mg), ketoprofen (100 mg) and dipirone (1 g) were used for postoperative analgesia. Propofol and remifentanil were withdrawn at surgery completion and patient was extubated 15 minutes after. Patient was eupneic, awaken, without pain, moving limbs, with respiratory frequency of 14 mpm and 97% oxygen saturation. Patient remained in the Intermediate Care Unit for 36 hours, with a nasal catheter of 2 L.min-1 O2 and was discharged in the 4th postoperative day. Total intravenous anesthesia, with short-lasting anesthetics without active metabolites has favored recovery and early extubation of a Myasthenia Gravis patient submitted to thymectomy.

Different intravenous, inhalational or combined anesthetic techniques have been used for videolaparoscopic cholecystectomy. This study aimed at comparing hemodynamic parameters, anesthetic recovery and side-effects of remifentanil associated to propofol or sevoflurane. Participated in this study 40 patients, who were divided in two groups: Group 1 (G1) - induced with 3 microg.ml-1 propofol and a 0.3 microg.kg-1.min-1 remifentanil infusion. Atracurium (0.5 mg.kg-1) was administered for tracheal intubation. Anesthesia was maintained with 2.5 to 3 microg.ml-1 propofol in target controlled infusion and 100% oxygen, and remifentanil by continuous infusion (0.3 microg.kg-1.min-1); Group 2 (G2) - induced with 6% sevoflurane and 100% oxygen at a 4 L.min-1 flow and a 0.3 microg.kg-1.min-1 remifentanil infusion. After loss of consciousness, sevoflurane concentration was decreased to 2% with a 2 L.min-1 oxygen flow. Similarly to G1, 0.5 mg.kg-1 atracurium was administered. A 0.3 microg.kg-1.min-1 remifentanil infusion was maintained throughout the surgery. Mean heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressure were measured in the following moments: M1, before anesthetic induction; M2, 1 minute before TI; M3, 1 minute after TI; M4, 5 minutes after TI; M5, 5 minutes after incision; M6 and M7, 10 and 30 minutes after pneumoperitoneum, respectively. After surgery, the time for eye opening, spontaneous ventilation, extubation, saying the complete name and anesthesiologists hand shaking under verbal command were measured in minutes: Atropine and ephedrine requirements, incidence of nausea, vomiting and pain were also evaluated. Hemodynamic changes (SBP, DBP, MBP and HR) and patients emergence time were not significantly different between groups. There were similar ephedrine and atropine requirements. Among complications only vomiting was higher incidence in group 2. Both techniques decrease blood pressure and heart rate. Anesthetic recovery was similar for both techniques. A higher incidence of vomiting was observed when remifentanil was associated to sevoflurane.