Myasthenia gravis: postop management

Advanced, Clinical - Neurologic

Ensure that the patient is reminded prior to induction of the possibility of a prolonged intubation

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.


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