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Anesthesia and Perioperative Considerations for Patients With Myasthenia Gravis
Shawn Collins1, Howard Roberts2, Ian Hewer3
1is associate dean, Academic Affairs and Graduate Nursing, Loma Linda University, Loma Linda, California.
AANA Journal
|November 21, 2020
Summary
Anesthesia for myasthenia gravis patients requires careful planning. Key recommendations include using sugammadex for neuromuscular blockade reversal and avoiding residual neuromuscular blockade before extubation.
Area of Science:
- Anesthesiology
- Neuromuscular Diseases
Background:
- Myasthenia gravis presents complex anesthetic challenges.
- Understanding its pathophysiology is crucial for perioperative care.
Purpose of the Study:
- To review anesthetic considerations for optimal perioperative care in myasthenia gravis patients.
- To discuss management strategies including pharmacology and risk factors.
Main Methods:
- Review of pathophysiology, crises (cholinergic and myasthenic).
- Discussion of perioperative management, including drug pharmacology (acetylcholinesterase inhibitors vs. sugammadex).
- Analysis of extubation criteria, pain management, and postoperative crisis risk factors.
Main Results:
- Sugammadex is recommended for reversing nondepolarizing neuromuscular blockade.
- Adequate spontaneous breathing and minimal residual neuromuscular blockade are essential for safe extubation.
- Limited use of opioids/sedatives and consideration of peripheral nerve blocks are advised.
Conclusions:
- Optimal perioperative care for myasthenia gravis involves specific anesthetic strategies.
- Avoiding routine ICU admission and careful extubation are key.
- Proactive management minimizes the risk of postoperative myasthenic crisis.
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