Anesthetic implications in patients with myasthenia gravis undergoing spine surgery

Abstract

Myasthenia gravis is a chronic autoimmune disorder affecting post-synaptic neuromuscular junction. It is characterized by skeletal muscle weakness and fatigability which improves with rest. The anesthesiologists may encounter these patients for thymectomy or sometimes for incidental surgeries. However, it is a real challenge for anesthesiologists because of the unpredictable response with muscle relaxants and analgesics and the possibility of ventilatory complications. In the present case report, we report the management of a 52-year-old female patient with myasthenia gravis who is posted for schwannoma surgery.

Myasthenia Gravis for Spine Surgery: An Ardous Anaesthetic Journey

“…One of the main concerns in patients with MG who are administered GA is related to the use of muscle relaxants, wherein the inherent muscle weakness can be compounded by both depolarizing and nondepolarizing muscle relaxants, causing difficulty in recovery from muscle paralysis and resumption of optimum muscular tone and respiratory functions [6][7][8]. To circumvent this concern, numerous studies have been carried out reporting that surgeries have been done under GA without using muscle relaxants [8,9]. Our case series is unique because of the administration of GA in a rare combination of patients with MG requiring spine surgery.…”