Ensure that the patient is reminded prior to induction of the possibility of a prolonged intubation.
Extubation: performed on awake patients and hopefully close to his/her baseline status. Reinstitute anticholinesterase medication, either by IV infusion or by reimplementation of the patient’s oral regimen.
Leventhal criteria: Predictive scoring system for the need for postoperative ventilation
1) duration of disease for 6 years or longer
2) chronic comorbid pulmonary disease
3) pyridostigmine dose >750 mg/d
4) VC <2.9L
5) Other indicators include preoperative use of steroids, and previous episode of respiratory failure.
These predictors have not been widely validated. (1)
Drugs to avoid: Calcium Channel blockers, Magnesium, Aminoglycoside antibiotics as all of these may contribute to muscle weakness
Post-Op Bed: Patients should be monitored in either a ICU or step-down unit but NOT to a conventional surgical ward.
- J B Eisenkraft, A E Papatestas, C H Kahn, C T Mora, R Fagerstrom, G Genkins Predicting the need for postoperative mechanical ventilation in myasthenia gravis. Anesthesiology: 1986, 65(1);79-82