Preoperative preparation and anesthetic management of patients with myasthenia gravis

Patients with myasthenia gravis have specific clinical problems that must be addressed by the anesthesiologist when surgery is contemplated. Optimal perioperative management of myasthenia gravis patients undergoing thymectomy requires careful preoperative assessment and preparation. This assessment and preparation includes evaluation for concomitant autoimmune, respiratory, and cardiac disorders as well as optimization of medical management for myasthenia. There are important intraoperative concerns to be addressed including appropriate monitoring, premedication, and other agents used during surgery including muscle relaxants and anesthetic agents. Postoperatively, attention must be directed specifically to pain relief, ventilatory management, and the appropriate titration of reversal agents and anticholinesterase inhibitors. Optimal management of all these factors maximizes the chance for successful and uncomplicated hospitalization.