Anesthesia and myasthenia gravis

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#anesthesia #anesthesia-epidural #anesthetics-inhalation #cholinesterase-inhibitors #humans

Anesthesia and myasthenia gravis

Blichfeldt-Lauridsen et al., 2012 | Acta Anaesthesiol Scand | Meta Analysis

Citation

Blichfeldt-Lauridsen L, Hansen B D. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand. 2012-Jan;56(1):17-22. doi:10.1111/j.1399-6576.2011.02558.x

Abstract

Myasthenia gravis (MG) is a disease affecting the nicotinic acetylcholine receptor of the post-synaptic membrane of the neuromuscular junction, causing muscle fatigue and weakness. The myasthenic patient can be a challenge to anesthesiologists, and the post-surgical risk of respiratory failure has always been a matter of concern. The incidence and prevalence of MG have been increasing for decades and the disease is underdiagnosed. This makes it important for the anesthesiologist to be aware of possible signs of the disease and to be properly updated on the optimal perioperative anesthesiological management of the myasthenic patient. The review is based on electronic searches on PubMed and a review of the references of the articles. The following keywords were used: myasthenia gravis AND neuromuscular blocking agents, myasthenia gravis AND sevoflurane, myasthenia gravis AND epidural, myasthenia gravis AND neuromuscular blockade reversal and myasthenia gravis AND pyridostigmine. The articles included were from reviews and clinical trials written in English. MG patients can easily be anesthetized without need for post-surgery mechanical ventilation whether it is general anesthesia or peripheral nerve block. Volatile anesthesia or the use of an epidural for the patient makes it possible to avoid the use of neuromuscular blocking agents, and when used, it should be in smaller doses and the patient should be carefully monitored. This review shows that with thorough pre-operative evaluation, continuing the daily pyridostigmine and careful monitoring the MG patient can be managed safely.

Key Findings

This review shows that with thorough pre-operative evaluation, continuing the daily pyridostigmine and careful monitoring the MG patient can be managed safely.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anesthesia
  • Anesthesia, Epidural
  • Anesthetics, Inhalation
  • Cholinesterase Inhibitors
  • Humans
  • Myasthenia Gravis
  • Neuromuscular Blocking Agents
  • Neuromuscular Nondepolarizing Agents
  • Postoperative Pain
  • Perioperative Care
  • Postoperative Care
  • Preoperative Care
  • Pyridostigmine Bromide
  • Respiration, Artificial
  • Sugammadex
  • gamma-Cyclodextrins

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Review
  • Vertical: niacin

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09