Anaesthesia in patients with myasthenia gravis

Myasthenia gravis is a chronic autoimmune disease characterised by progress ive weakness and easy fatigability of voluntary skeletal muscles. These sym ptoms are related to a decrease in the number of functional acetylcholine r eceptors, impaired neuromuscular transmission, and a broadened neuromuscula r cleft. Symptomatic treatment is based on anticholinesterases in order to increase the synaptic dwell of acetylcholine. Immune therapy includes immun e suppressive drugs, plasma exchange, immunoglobulins, and thymectomy. Anticholinesterase therapy should be continued in the current mode until an aesthesia. Regional anaesthesia should be preferred. Although sensitivity t o non-depolarising neuromuscular blocking agents is increased, muscle relax ants can be administered during general anaesthesia as long as neuromuscula r monitoring assesses their individual effect. Due to the individual variab ility in the response to muscle relaxants, accurate titration in combinatio n with pre- and intraoperative neuromuscular monitoring is essential for my asthenic patients. Postoperatively, intensive care observation is mandatory including neuromuscular monitoring.