J Dent Anesth Pain Med.  2019 Feb;19(1):67-72. 10.17245/jdapm.2019.19.1.67.

Anesthetic considerations for a patient with myasthenia gravis undergoing deep sedation in an outpatient oral surgery setting

Affiliations
  • 1Triangle Implant Center, Durham, NC, USA. saad.khan92294@gmail.com
  • 2Wake Forest School of Medicine, Winston-Salem, NC, USA.

Abstract

Myasthenia gravis (MG) is a neuromuscular autoimmune disorder which clinically presents as muscular weakness and fatigue due to autoantibody formation against acetylcholine receptors (AChR), leading to their subsequent destruction. Due to the neuromuscular implications of MG, certain considerations must be taken into account when providing anesthesia to MG patients. In the following case report, we have outlined procedural considerations for the anesthetic management of a patient with MG undergoing deep sedation for an elective oral surgery in an outpatient setting, as well as a discussion of relevant literature.

Keyword

Anesthesia; Myasthenia Gravis; Oral Surgery

MeSH Terms

Anesthesia
Deep Sedation*
Fatigue
Humans
Muscle Weakness
Myasthenia Gravis*
Outpatients*
Receptors, Cholinergic
Surgery, Oral*
Receptors, Cholinergic

Figure

  • Fig. 1 Pathophysiologic pathways of MG: (1) AChR autoantibody destruction, (2) ACh binding site blockage, (3) Complement-mediated destruction of AChR and motor end plate.


Reference

1. Tamburrini A, Tacconi F, Barlattani A, Mineo TC. An update on myasthenia gravis, challenging disease for the dental profession. J Oral Sci. 2015; 57:161–168.
Article
2. Keesey JC. Clinical evaluation and management of myasthenia gravis. Muscle Nerve. 2004; 29:484–505.
Article
3. Thavasothy M, Hirsch N. Myasthenia gravis. BJA CEPD Reviews. 2002; 2:88–90. Available from: http://dx.doi.org/10.1093/bjacepd/2.3.88.
Article
4. Wendell LC, Levine JM. Myasthenic crisis. Neurohospitalist. 2011; 1:16–22.
Article
5. Gilhus NE. Myasthenia Gravis. N Engl J Med. 2016; 375:2570–2581.
Article
6. Drachman DB. Myasthenia Gravis. N Engl J Med. 1994; 330:1797–1810.
Article
7. Ha JC, Richman DP. Myasthenia gravis and related disorders: Pathology and molecular pathogenesis. Biochim Biophys Acta. 2015; 1852:651–657.
Article
8. Daroff RB. The office Tensilon test for ocular myasthenia gravis. Arch Neurol. 1986; 43:843–844.
Article
9. Jamal BT, Herb K. Perioperative management of patients with myasthenia gravis: Prevention, recognition, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107:612–615.
Article
10. Osserman K. Myasthenia Gravis. Grune & Stratton;1958. p. 78–80.
11. Yarom N, Barnea E, Nissan J, Gorsky M. Dental management of patients with myasthenia gravis: A literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:158–163.
Article
12. Patil PM, Singh G, Patil SP. Dentistry and the myasthenia gravis patient: A review of the current state of the art. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114:e1–e8.
Article
13. Abel M, Eisenkraft JB. Anesthetic implications of myasthenia gravis. Mt Sinai J Med. 2002; 69:31–37.
14. Ceremuga TE, Yao XL, McCabe JT. Etiology, mechanisms, and anesthesia implications of autoimmune myasthenia gravis. AANA J. 2002; 70:301–310.
15. Muckler VC, O'Brien JM, Matson SE, Rice AN. Perianesthetic implications and considerations for myasthenia gravis. J Perianesth Nurs. 2019; 34:4–15.
Article
16. Fukayama H. Which Is Better-Conscious Sedation or Deep Sedation? Anesth Prog. 1995; 42:100–102.
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