Myasthenia Gravis

• Etiology/Risk Factors
  • Multifactorial
  • Genetic [86]
  • Thymoma [87]
  • Female gender
• Pathophysiology
  • Autoimmune antibodies target and destroy post‐synaptic type 1 nicotinic receptors (Figure 6.28)
    • Fatigable weakness of skeletal muscles
• Treatment [88]
  • Cholinesterase inhibitors
    • Neostigmine
    • Pyridostigmine
    • Physostigmine
  • Thymectomy
  • Immunosuppressants
  • Steroids
  • IVIG
  • Plasmapheresis
• Primary Concerns
  • ↑ Risk of perioperative respiratory events from muscle weakness
    • ↑ Risk of upper airway obstruction due to decreased muscle tone [89]
  • ↑ Risk of aspiration
    • Swallowing difficulty
    • Pharyngeal weakness
• Evaluation
  • Consider neurology consult
  • May have recent PFTs
  • Evaluate baseline strength
  • History
    • Respiratory symptoms
    • Last crisis
    • Need for intubation during exacerbation
• Anesthesia Management
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