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Myasthenia gravis: postop management

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.

References

  1. 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 PubMed Link

Other References

  1. Keys to the Cart: October 16, 2017; A 5-minute video review of ABA Keywords Link