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Thursday, December 5, 2013
Myasthenia Gravis and Anesthesia
My Mom is 70 years old and needs to have a spinal fusion of L2. She has been diagnosed with Myasthenia Gravis and is very weak from it. Her neurologist told her she didnt think that my mom would be able to withstand surgery and that she would be ventilator dependant afterwards. Do you think this is so? If so what are the chances that she would be able to come off the ventilator after surgery?
Patients with severe myasthenia gravis do have a higher risk of complications after major surgery. Depending on the severity of the disease, there may even be a risk of ventilator-dependence. However each patient is an individual so their condition must be carefully assessed, and the need for the surgery must be weighed against the risk of harm.
Markers of severity would include symptoms (shortness of breath), previous breathing problems after surgery/anesthesia, poor results on lung function testing, and high doses of medication taken for the myasthenia. Spinal fusion is not usually an emergency procedure and is often discretionary. So you should have time to carefully evaluate the risks and benefits of the procedure before going ahead. Also, myasthenia is a disease that can have fluctuations so it would be best to spend time and effort optimising her treatment and her general condition if the decision is to proceed with the surgery.
Any major surgery in a 70 year-old is a challenge, not only because of the immediate recovery phase, but also because of the potentially prolonged and arduous recovery process from the surgery itself. If the procedure is done, a meeting with the anesthesiologist beforehand is a good idea. Muscle relaxants must be minimised or even avoided, and care in ICU postoperatively is a definite consideration.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University