Myasthenia gravis (MG) and anaesthesia

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Myasthenia gravis (MG) and anaesthesia. Use neuromuscular monitoring, Use deep inhalational anaesthesia. Fully referenced neurology checklist.

Precautions

  • Use neuromuscular monitoring
  • Use deep inhalational anaesthesia
  • Ensure train-of-four (TOF) of >90% before terminating anaesthesia
  • Avoid mechanical ventilation if possible

Anaesthetic agents and MG

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Cholinesterase inhibitors and anaesthesia

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Azathioprine and anaesthesia

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Peri-operative pain control

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Pre-operative optimisation of myasthenic control

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Acronym

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References

  1. Blichfeldt-Lauridsen L, Hansen BD. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand 2012; 56:17-22.
  2. Rudzka-Nowak A, Piechota M. Anaesthetic management of a patient with myasthenia gravis for abdominal surgery using sugammadex. Arch Med Sci 2011; 7:361-364.
  3. de Boer HD, van Egmond J, Driessen JJ, Booij LH. A new approach to anesthesia management in myasthenia gravis: reversal of neuromuscular blockade by sugammadex. Rev Esp Anestesiol Reanim 2010; 57:181-184.
  4. Claytor B, Cho SM, Li Y. Myasthenic crisis. Muscle Nerve 2023; 68:8-19.

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