Keyword
Myasthenia gravis
Definition
Nicotinic acetylcholine receptors antibodies로 인한 skeletal muscle neuromuscular junctions의 Autoimmune disorder
Signs & Symptoms
Osserman Classification System for Myasthenia Gravis
Treatment
Patients are usually treated with thymectomy, anticholinesterase(severe case), and immunosuppressant medications (corticosteroids, azathioprine, cyclosprine)
Preoperative evaluation
Patients taking azathioprine -> CBC and LFTs (drug-induced bone marrow suppression, liver dysfunction)
Patients treated with steroids need glucose measurement, Steroids는 지속 필요
Anticholinesterase 지속 필요
Management of anesthesia
Anticholinesterase tx. -> muscle relaxant dosage reassessment 필요
succinylcholine resistance, prolonged response, antagonize the effect of nondepolarizing muscle relaxant 때문에 anticholinergic drugs -> withheld for 6 hours preoperatively, 환자의 sensitivity 바뀔 수 있어 수술 후 medication은 재조정 필요함
Corticosteroid tx. -> succinylcholine 에 영향 없으나 vecuronium(steroidal muscle relaxant)에 resistance
significant bulbar weakness, vital capacity < 40mL/kg -> pyridostigmine 750mg/daily
Rapid recovery of neuromuscular function in patients receiving rocuronium when sugammadex was used for reversal.
Reference
Miller’s Anesthesia, 8th edition, Chapter 38: Preoperative Evaluation p.1129
Miller’s Anesthesia, 8th edition, Chapter 39: Anesthetic Implications of Concurrent Diseases p.1200-1201
Stoelting’s anesthesia and co-existing disease, Chapter 21. Skin and musculoskeletal diseases p.448-451