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.
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