This study evaluated the oral toxicity of pyridostigmine bromide in Sprague-Dawley rats when administered for 13 weeks by daily gavage. Groups of 10 rats/sex received doses of 0, 5, 15, 30, or 60 mg/kg/day. Toxicity w...This study evaluated the oral toxicity of pyridostigmine bromide in Sprague-Dawley rats when administered for 13 weeks by daily gavage. Groups of 10 rats/sex received doses of 0, 5, 15, 30, or 60 mg/kg/day. Toxicity was limited to exaggerated cholinergic stimulation at doses of 15 mg/kg/day or greater. Significant findings included tremors and inhibition of RBC acetylcholinesterase. Thus, 5 mg/kg/day of pyridostigmine bromide appears to be the no observed toxic effect level under the conditions of the present investigation.展开更多
Anticholinesterase does not allow adequate reversal of the deep neuromuscular blockade (NMB) achieved using high doses of relaxants. A 71-year-old female patient (weight 70 kg, height 169 cm) was scheduled for a trans...Anticholinesterase does not allow adequate reversal of the deep neuromuscular blockade (NMB) achieved using high doses of relaxants. A 71-year-old female patient (weight 70 kg, height 169 cm) was scheduled for a transurethral resection of a bladder tumor under general anesthesia. We administered rocuronium 30 mg (0.43 mg/kg) for tracheal intubation due to an estimated short surgical time. During the operation, an additional rocuronium 10 mg was injected. The surgical procedure ended abruptly 10 minutes after receiving the last dose of rocuronium. At the end of surgery, the patient received pyridostigmine as a reversal. However, residual NMB persisted, and neuromuscular monitoring did not show the expected degree of recovery. Sugammadex 2 mg/kg was used, and the patient experienced complete reversal from NMB in just 2 min.展开更多
Cardiovascular adverse events in patients with myasthenia gravis (MG) are rare, but the early recognition of such events is crucial. We describe a case of a noncoronary myocardial infarction (MI) during the initial tr...Cardiovascular adverse events in patients with myasthenia gravis (MG) are rare, but the early recognition of such events is crucial. We describe a case of a noncoronary myocardial infarction (MI) during the initial treatment period with pyridostigmine bromide in a female patient with MG. Clinicians should be cautious about the appearance of potential MI in patients with MG. A baseline electrocardiogram is advocated, when the early recognition of the MI clinical signs and the laboratory findings (myocardial markers) are vital to the immediate and appropriate management of this medical emergency, as well as to prevent future cardio-vascular events. In this case report possible causes of myocardial adverse events in the context of MG, which may occur during the ongoing treatment and the clinical course of the disease, are discussed.展开更多
Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junctionthat has higher incidence in younger women than men, which could be related todifferences in sex hormones physiology and immune system function...Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junctionthat has higher incidence in younger women than men, which could be related todifferences in sex hormones physiology and immune system functioning betweenmales and females. MG can first present during pregnancy and variably affectpregnancy, labor, and postpartum period. In this paper, we had an updatedoverview on our understanding about MG presentation and its effect onpregnancy and vice versa, therapeutic options for MG pregnant women,management of pregnancy or labor complications in MG patients, and finally fetaland neonatal considerations in MG pregnant women. A multidisciplinaryapproach, involving obstetricians/gynecologists, neurologists, and anesthesiologists,plays a pivotal role in improving the clinical outcomes in both MGmothers and their infants during pregnancy, delivery and postpartum.展开更多
文摘This study evaluated the oral toxicity of pyridostigmine bromide in Sprague-Dawley rats when administered for 13 weeks by daily gavage. Groups of 10 rats/sex received doses of 0, 5, 15, 30, or 60 mg/kg/day. Toxicity was limited to exaggerated cholinergic stimulation at doses of 15 mg/kg/day or greater. Significant findings included tremors and inhibition of RBC acetylcholinesterase. Thus, 5 mg/kg/day of pyridostigmine bromide appears to be the no observed toxic effect level under the conditions of the present investigation.
文摘Anticholinesterase does not allow adequate reversal of the deep neuromuscular blockade (NMB) achieved using high doses of relaxants. A 71-year-old female patient (weight 70 kg, height 169 cm) was scheduled for a transurethral resection of a bladder tumor under general anesthesia. We administered rocuronium 30 mg (0.43 mg/kg) for tracheal intubation due to an estimated short surgical time. During the operation, an additional rocuronium 10 mg was injected. The surgical procedure ended abruptly 10 minutes after receiving the last dose of rocuronium. At the end of surgery, the patient received pyridostigmine as a reversal. However, residual NMB persisted, and neuromuscular monitoring did not show the expected degree of recovery. Sugammadex 2 mg/kg was used, and the patient experienced complete reversal from NMB in just 2 min.
文摘Cardiovascular adverse events in patients with myasthenia gravis (MG) are rare, but the early recognition of such events is crucial. We describe a case of a noncoronary myocardial infarction (MI) during the initial treatment period with pyridostigmine bromide in a female patient with MG. Clinicians should be cautious about the appearance of potential MI in patients with MG. A baseline electrocardiogram is advocated, when the early recognition of the MI clinical signs and the laboratory findings (myocardial markers) are vital to the immediate and appropriate management of this medical emergency, as well as to prevent future cardio-vascular events. In this case report possible causes of myocardial adverse events in the context of MG, which may occur during the ongoing treatment and the clinical course of the disease, are discussed.
文摘Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular junctionthat has higher incidence in younger women than men, which could be related todifferences in sex hormones physiology and immune system functioning betweenmales and females. MG can first present during pregnancy and variably affectpregnancy, labor, and postpartum period. In this paper, we had an updatedoverview on our understanding about MG presentation and its effect onpregnancy and vice versa, therapeutic options for MG pregnant women,management of pregnancy or labor complications in MG patients, and finally fetaland neonatal considerations in MG pregnant women. A multidisciplinaryapproach, involving obstetricians/gynecologists, neurologists, and anesthesiologists,plays a pivotal role in improving the clinical outcomes in both MGmothers and their infants during pregnancy, delivery and postpartum.
