[Anesthesia in patients with myasthenia gravis]

Myasthenia gravis is a chronic autoimmune disease characterised by progressive weakness and easy fatigability of voluntary skeletal muscles. These symptoms are related to a decrease in the number of functional acetylcholine receptors, impaired neuromuscular transmission, and a broadened neuromuscular cleft. Symptomatic treatment is based on anticholinesterases in order to increase the synaptic dwell of acetylcholine. Immune therapy includes immune suppressive drugs, plasma exchange, immunoglobulins, and thymectomy. Anticholinesterase therapy should be continued in the current mode until anaesthesia. Regional anaesthesia should be preferred. Although sensitivity to non-depolarising neuromuscular blocking agents is increased, muscle relaxants can be administered during general anaesthesia as long as neuromuscular monitoring assesses their individual effect. Due to the individual variability in the response to muscle relaxants, accurate titration in combination with pre- and intraoperative neuromuscular monitoring is essential for myasthenic patients. Postoperatively, intensive care observation is mandatory including neuromuscular monitoring.