Abstract
Myasthenia gravis impairs neuromuscular transmission. Its therapy is pharmacological, immunological and surgical by thymectomy.
Surgery, anaesthesia and other factors can induce exacerbation of myasthenia. The safest technique of anaesthesia has not been determined.
Anaesthesia without muscle relaxation recommended, either deep inhalational anaesthesia, or propofol with opioids, or regional anaesthesia. If neuromuscular blocking agents are needed to create a motionless surgical field, the main problem is neuromuscular transmission impairment.
Myasthenic patients react on these agents unpredictably. The most feared complication is a prolonged effect preventing spontaneous ventilation with an increased risk of aspiration and a decreased reaction to hypoxia.
In these circumstances mechanical ventilation can be continued. Pharmacological reversal can be attempted but it can induce a cholinergic crisis and its effect is usually limited.
A new possibility is the use of rocuronium for muscle relaxation with reversal by sugammadex. Rocuronium and sugammadex could offer a new, effective and safe approach to general anaesthesia in myasthenic patients.