[Preparation before anesthesia for patients with myasthenia gravis]

Myasthenia gravis (MG) is an autoimmune disease resulting from the production of antibodies against the acetylcholine receptors of the neuromuscular synapse, and is the disease characterized by weakness and fatigability of the skeletal muscle, with improvement following rest. Adequate preoperative evaluation of the MG patients must be carried out. Especially, the preoperative evaluation of respiratory muscle strength is very important. Although several general anesthetic techniques have been proposed, none has been proven to be superior to the others. It is necessary to evaluate anesthetic management of MG patients according to the severity of the individual patient. But the use of regional anesthesia seems to be warranted whenever possible. Based on the preoperative severity, operative procedure and perioperative management, extubation should be carried out carefully in all MG patients. MG is a disease with many pitfalls in the safe administration of anesthesia.