Title: Myaesthenia Gravis: An Anaesthetic Challenge
Authors: Dr Anuradha Malliwal, Dr Rochana Bakhshi, Dr Meenal Agarwal
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.22
Myaesthenia gravis (MG) is a chronic autoimmune neuromuscular disorder characterized by fluctuating skeletal muscle weakness that worsens with exertion and improves after a period of rest/anti-cholinesterase medication. We report the anaesthetic management of an elderly myaesthenic patient scheduled for cholecystectomy with Common Bile Duct (CBD) exploration under general anaesthesia. Respiratory muscle weakness and interference of anti-cholinesterase medication with anaesthetic drugs are important concerns in such cases. Keywords: myasthenia gravis, respiratory muscle weakness, anticholinesterase medication Conti-Fine BM, Milani M, Kaminski HJ. Myasthenia gravis: past, present, and future. J Clin Invest. 2006; 116: 2843–54. Abel M, Eisencraft JB. Anesthetic implications of myasthenia gravis. Mt Sinai J Med 2005; 69:31-37 Eisencraft JB, Book WJ, Mann SM, et al. Resistance to succinylcholine in myasthenia gravis. A dose response study. Anaesthesiology 1988; 69: 760-763 . Wainwright AP, Broderick PM. Suxamethonium in myasthenia gravis. Anaesthesia1987; 42: 950-957. Abel M, Eisencraft JB, Patel N. Response to suxamethonium in a myasthenic patient during remission. Anaesthesia 1991; 46:30-32. McCaul C, Tobin E, Boylan JF, McShane AJ. Atracurium is associated with postoperative residual curarization.Br J Anaesth.2002; 89:766-9 Grant RP, Jenkins LC. Prediction of the need for postoperative mechanical ventilation in myasthenia gravis: thymectomy compared to other surgical procedures. Can Anaesth Soc J 1982 Mar,29(2):112-6Abstract
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