| Cholinergic crisis results from relative overdosing
of anticholinesterases and overstimulation of the muscarinic cholinergic
receptors. Signs and symptoms include weakness, salivation, lacrimation,
bronchorrhea, pulmonary edema, miosis, urinary incontinence, diarrhea.
Treatment includes IV atropine.
Myasthenic crisis results from inadequate dosing of anticholinesterases
and may be precipitated by infections, exertion, menstruation,
emotional stress and acute illness. Signs and symptoms include
weakness, acute respiratory insufficiency, mydriasis, improvement
with edrophonium (2-10 mg).
Myasthenic (Eaton-Lambert) syndrome is caused by decreased
release of acetylcholine at the neuromuscular junction. It is
characterized by proximal limb muscle weakness (that improves
with exercise) and is associated with malignancy, sarcoidosis,
thyroiditis and collagen-related vascular disease. Anesthetic
considerations include:
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Consider rapid sequence induction
with Sellick maneuver. |
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Consider adequate hydration
before induction and insertion of a urinary catheter. |
| |
Both depolarizing and non-depolarizing
muscle relaxants may have prolonged effect. |
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Autonomic nervous system
dysfunction may result in gastroparesis, orthostatic hypotension
and urinary retention. |
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