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Abstract

Myasthenia gravis (MG) is a neurological disorder involving the post-synaptic neuromuscular junction and is caused by the autoimmune destruction of acetylcholine receptors with ensuing muscular weakness. Rarely is the disease process in MG compounded with other comorbidities and distinctive surgical challenges, such as the prone position in spine surgery, presenting unique challenges in the anesthetic management of such cases. This case series and the ensuing discussion describe the successful perioperative management of two cases of MG undergoing neuro-surgical management for lumbar spine pathologies.

Introduction

Myasthenia gravis is an autoimmune disorder that specifically targets and reduces the availability of nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction. It is characterized by a fatigable weakness of skeletal muscles that improves on rest and is associated with disorders such as hypothyroidism, rheumatoid arthritis, systemic lupus erythematosus, and diabetes mellitus. Anesthetic management of cases of MG poses unique challenges due to the pathological factors involved and their interplay with medications used in administering anesthesia [1]. Peri-operative management of spine surgery in itself is challenging, and it adds up more when a patient has a case of MG.

Case Presentation

Case 1

A 40-year-old female was a known case of hypertension, diabetes mellitus, dyslipidemia, and MG (Class IIa), diagnosed two years ago. Following an episode of myasthenic crisis, she was tracheostomized and still had the tracheostomy tube in situ. Presently, she was scheduled for an elective dorsal decompressive laminectomy in view of severe neurological symptoms of back pain and radiculopathy due to prolapsed...(More)

For more info please read, Myasthenia Gravis for Spine Surgery: An Ardous Anaesthetic Journey, by Cureus