Research & Innovation in Anesthesia

Register      Login

VOLUME 4 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Myasthenia Gravis and Anesthesia Challenges

Minal Harde, Bhadade Rakesh

Keywords : Anesthesia, Muscle relaxants, Myasthenia gravis, Neuromuscular junction

Citation Information : Harde M, Rakesh B. Myasthenia Gravis and Anesthesia Challenges. Res Inno Anesth 2019; 4 (2):36-39.

DOI: 10.5005/jp-journals-10049-0070

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Myasthenia gravis (MG) is an autoimmune disorder affecting nicotinic acetylcholine receptors at the post-synaptic site in the neuromuscular junction (NMJ). Myasthenia gravis presents with muscle weakness and fatigability of varying degrees affecting many muscle groups, mainly proximal skeletal muscles, ocular, respiratory, and bulbar. Myasthenia gravis has many implications for safe management of anesthesia. They are due to the disease process, association with other autoimmune diseases [diabetes mellitus (DM), thyroid disorders, systemic lupus erythematosis (SLE), rheumatoid arthritis (RA)], the medications used for treatment, potential for respiratory compromise, interaction of many anesthetic drugs in particular being resistance to suxamethonium, and high sensitivity to nondepolarizing muscle relaxants [neuromuscular blockers (NMB)]. Hence, detailed knowledge of the disease is necessary to the anesthesiologist for successful perioperative management and outcome.

  1. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology 2016;87(4):419–425. DOI: 10.1212/WNL.0000000000002790.
  2. Murai H. Japanese clinical guidelines for myasthenia gravis: putting into practice. Clin Exp Neuroimmunol 2015;6(1):21–31. DOI: 10.1111/cen3.12180.
  3. Conti-Fine BM, Milani M, Kaminski HJ. Myasthenia gravis: past, present, and future. J Clin Invest 2006;116(11):2843–2854. DOI: 10.1172/JCI29894.
  4. Thanvi BR, Lo TCN. Update on myasthenia gravis. Postgrad Med J 2004;80(950):690–700. DOI: 10.1136/pgmj.2004.018903.
  5. Postevka E. Anesthetic implications of myasthenia gravis: a case report. AANA J 2013;81(5):386–388. DOI: 10.23937/2377-4630/2/1/1022.
  6. Başkan S, Örnek D, Güney A, et al. Management of anaesthesia in a patient with myasthenia gravis. Int J Anesthetic Anesthesiol 2015;2:022.
  7. El-Dawlatly AA. Anaesthesia for thoracoscopic thymectomy: modified non-muscle relaxant technique—case reports. Middle East J Anaesthesio 2007;19(1):219–224.
  8. Katz JA, Murphy GS. Anesthetic consideration for neuromuscular diseases. Curr Opin Anaesthesiol 2017;30(3):435. DOI: 10.1097/ACO.0000000000000466.
  9. Gritti P, Sgarzi M, Carrara B, et al. A standardized protocol for the perioperative management of myasthenia gravis patients. Experience with 110 patients. Acta Anaesthesiol Scand 2012;56(1):66. DOI: 10.1111/j.1399-6576.2011.02564.x.
  10. Marik PE, Varon J. Requirement of perioperative stress doses of corticosteroids: a systematic review of the literature. Archives of Surgery 2008;143(12):1222–1226. DOI: 10.1001/archsurg.143.12.1222.
  11. Bergmann I, Szabanowski T, Bräuer A, et al. Remifentanil added to sufentanil-sevoflurane anaesthesia suppresses hemodynamic and metabolic stress responses to intense surgical stimuli more effectively than high-dose sufentanil-sevoflurane alone. BMC Anesthesiol 2015;15(1):3. DOI: 10.1186/1471-2253-15-3.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.