Etiology, mechanisms, and anesthesia implications of autoimmune myasthenia gravis

Myasthenia gravis (MG) is the prototypical neurological autoimmune disease. It is characterized by muscle weakness that progressively worsens on repetition but improves with rest. Muscle weakness and fatigability arise from defective or decreased acetylcholine receptors at the neuromuscular junctions, where nerve signals from spinal motor neurons that innervate muscles cannot effectively induce muscle contraction. Several mechanisms of pathogenesis lead to the MG syndrome. The most prevalent cause of MG is an autoimmune disorder in which the patient produces antibodies that attack the nicotinic acetylcholine receptor at the neuromuscular junction. Anesthesia management of the patient with MG is challenging and requires specific management; however, safe and successful outcomes are achievable. This course emphasizes the autoimmune neuromuscular defect in MG, current treatments for this syndrome, contraindications of certain anesthetic drugs in this condition, and anesthetic management of a patient with MG in the operating room environment.