Myasthenia Gravis
Patient (condition)
 
Aliases:
Myasthenia Gravis (MG)

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Autoimmune neuromuscular disorder characterised by fatiguable skeletal muscle weakness.
Auto-antibodies competitively bind to acetylcholine receptors in the neuromuscular junction.
Severity varies from a mild limb weakness, to a myasthenic crisis characterised by ventilator dependent respiratory failure.

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Aug 09, 2012
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Primary anaesthetic considerations are preoperative optimisation, risk assessment for postoperative ventilation, and enhanced effects of non-depolarising muscle relaxants.

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Aug 09, 2012
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A disorder of neuromuscular transmission characterized by weakness of cranial and skeletal muscles. Autoantibodies directed against acetylcholine receptors damage the motor endplate portion of the NEUROMUSCULAR JUNCTION, impairing the transmission of impulses to skeletal muscles. Clinical manifestations may include diplopia, ptosis, and weakness of facial, bulbar, respiratory, and proximal limb muscles. The disease may remain limited to the ocular muscles. THYMOMA is commonly associated with this condition. (Adams et al., Principles of Neurology, 6th ed, p1459)
www.nlm.nih.gov/cgi/mesh/...

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Oct 23, 2012
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Types:
I - Ocular symptoms only.
IIA - Generalised mild weakness, responds to therapy.
IIB - Generalised moderate weakness, responds less well to therapy.
III - Acute fulminating presentation +/- resp dysfunction.
IV - Myasthenic crisis. refl.in/cq

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Mar 10, 2012
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Bulbar palsy is common. If present, the patient is at risk of requiring post operative ventilation following major surgery. refl.in/8s

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Nov 27, 2012
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Thyroid function testing is essential as approximately 15% of MG patients have some abnormality of the gland. refl.in/mg

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May 18, 2011
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Continuation of drug therapy is critical. Place a nasogastric tube if necessary. Parenteral route if GIT failure

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Nov 27, 2012
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Continue anticholinesterase therapy up to the time of surgery. There is no documented decrease effect of NDMR from this. refl.in/2y

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Mar 14, 2013
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Consider admitting patients undergoing major elective surgical procedures 48 hrs prior to surgery for optimisation. refl.in/mg

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Nov 02, 2011
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Patients with severe MG may need a course of plasma exchange or i.v. immunoglobulin before surgery is considered. refl.in/mg

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May 18, 2011
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If suxamethonium is used, do not use any other neuromuscular blocker until the patient's muscle function has returned and no fade is present refl.in/2x

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Dec 19, 2011
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Lower dose of non-depolarising muscle relaxants will likely required. 10-20% usual dose & monitor with nerve stimulator. refl.in/30

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Aug 09, 2011
This suggests 10-20% for pancuronium, 30-40% for atracurium. refl.in/mg
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May not depolarise to suxamethonium (reduced number of available ACh receptors). Larger dose >1.5mg/kg may overcome this. refl.in/31

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Sep 14, 2011
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Neostigmine reversal works, but avoidance is preferred. May lead to anticholinesterase overdose & cholinergic crisis refl.in/2z

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May 18, 2011
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Non-depolarising muscle relaxants NMDR may not be needed. To be used with caution. May result in prolonged relaxation.

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May 18, 2011
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Plasmapheresis depletes plasma esterase levels, possibly prolonging the effect of suxamethonium, mivacurium, and ester-linked local anaesthetics.

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Dec 19, 2011
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Predictors of postop ventilation: Major cavity surgery; disease duration >6yrs; chronic respiratory disease; daily pyrodostigmine >750mg; FVC <2.9L refl.in/8q

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Jul 02, 2011
This is from data from a series of 24 patients in 1980. A 1996 paper (54 pts) found disease duration, drug dose, & history of chronic resp disease not to be important. refl.in/8r
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Good review paper on juvenile myasthenia gravis outlining the differences with adult presentations, particularly the difference between autoimmune and congenital myasthenic-syndromes.

dx.doi.org/10.4061/2011/4...

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Mar 14, 2013
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