Anesthesia for Patients With Myasthenia Gravis

Excerpt

Neuromuscular diseases significantly contribute to both morbidity and mortality. Myasthenia gravis, an autoimmune disorder characterized by skeletal muscle weakness and fatigue, results from the destruction of post-synaptic nicotinic acetylcholine receptors at the neuromuscular junction, impairing normal muscle function.

Patients with myasthenia gravis typically experience worsening muscle weakness as the day progresses or after physical exercise or exertion, with symptoms improving after rest. Deep tendon reflexes remain intact, and autonomic dysfunction is uncommon. However, as the disease advances, respiratory muscle involvement becomes a significant concern, increasing the risk of perioperative respiratory compromise.

The complex interplay between disease progression and the effects of commonly used treatments—such as acetylcholinesterase inhibitors, corticosteroids, and immunosuppressants—presents unique challenges for anesthesia management. These factors necessitate a carefully tailored approach to anesthetic planning, neuromuscular blockade, and postoperative monitoring to ensure optimal patient safety and outcomes. Lambert-Eaton syndrome, various myasthenic syndromes, and other neuromuscular disorders are not discussed in detail here.