Anaesthesia
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We describe the anaesthetic management of a 72-year-old man with myasthenic syndrome. Pre-operatively, he was treated with 3,4-diaminopyridine and showed a strong hand grip. During general anaesthesia with nitrous oxide and sevoflurane in oxygen, a mechanomyograph and two accelerographs were set up for the hands and left foot to monitor neuromuscular function. ⋯ After discontinuation of sevoflurane, responses to train-of-four stimulation remained small, but a strong response to tetanic stimulation was observed, with post-tetanic facilitation. Extubation was successful, and recovery from anaesthesia was uneventful. Tetanic stimulation and post-tetanic facilitation are important in monitoring neuromuscular function in patients with myasthenic syndrome whose train-of-four responses are insufficient.
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Letter Case Reports
Capnography can aid in diagnosis of tracheobronchial injury.