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Anesthesia

Myasthenia Gravis and anesthesia

06/23/2008

Question:

I am considering a facelift and breast augmentation and have Myasthenia Gravis treated with medication and thymectomy two years ago. What considerations should my anesthetist be aware of prior to surgery?

Answer:

Myasthenia gravis, although relatively rare, is a condition that any anesthesiologist will be familiar with because of some fairly well-known anesthetic implications. These include: muscle weakness that may affect your breathing and your airway; a possible increased susceptibility to the effects of sedative medication; a dramatically increased sensitivity to muscle relaxant medication; the effects of medication used to treat the condition, (which may include steroids), and their interaction with anesthetic drugs. In general, anesthesia for patients with myasthenia involves minimizing or avoiding the use of muscle relaxants. Various forms of local or regional anesthesia may be good choices, depending on the type of surgery.

It is clear then that a person with myasthenia gravis could have an increased risk of harm from anesthesia and/or surgery. As your surgery is elective, the first decision is whether your condition is sufficiently mild, and stable, to allow it to be done with minimum risk to your health. The best venue for surgery is another decision as high risk patients should not be operated on in a physician's office, and may need to monitored in a hospital setting overnight. How your myasthenia medication is handled is another question. If it is withheld before and during your surgery will this worsen your condition?

For these reasons, a careful evaluation of your condition before surgery, with input from your physician/neurologist, is recommended to allow your anesthesiologist to assess your risk and suggest an appropriate venue and a low risk plan for anesthesia. Breast augmentation and a facelift at one sitting might be ambitious.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University