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
duration of disease for 6 years or longer
chronic comorbid pulmonary disease
pyridostigmine dose >750 mg/d
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.