Global Perspectives on Obstetric Anesthesia: Challenges and Priorities for Advancing Maternal Health

Myasthenia gravis is an autoimmune disease of the neuromuscular system. In myasthenia gravis there is autoantibody destruction of postsynaptic acetylcholine receptors. This leads to weakness and fatigue of skeletal muscles after exercise that usually improves with rest or with anticholinesterase medications. Patients with myasthenia gravis who undergo surgery and anesthesia are at higher risk for postoperative weakness and are exquisitely sensitive to nondepolarizing neuromuscular blockade. Criteria that increase the risk for postoperative mechanical ventilation in patients with myasthenia gravis (most of these indicate increased severity of disease) include: 1. Duration of disease >6 years 2. Vital capacity < 2.9 L (or < 40 mL/kg) 3. Presence of pulmonary disease (ex. COPD, Asthma) 4. Daily pyridostigmine dose >750 mg 5. Negative inspiratory force < 20 cm H2O