Category: Pharmacology & Therapeutics
Keywords: Myasthenia gravis, Myasthenic crisis, neuromuscular blocker, paralytic, rocuronium, vecuronium, succinylcholine (PubMed Search)
Posted: 4/1/2023 by Matthew Poremba
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Myasthenia gravis is an autoimmune disease of the neuromuscular junction, most commonly due to antibodies attacking acetylcholine receptors in the postsynaptic membrane. Up to 30% of patients with myasthenia gravis will experience a myasthenic crisis during their disease course. If rapid sequence intubation is indicated, the unique characteristics of this patient population must be considered in the event use of a paralytic is necessary. All paralytic agents can be expected to last significantly longer, and an unpredictable response may be seen with depolarizing agents - therefore non-depolarizing agents are preferred in this population.
Non-Depolarizing Agents (Rocuronium, Vecuronium)
Depolarizing Agents (Succinylcholine)
Roper J, Fleming ME, Long B, Koyfman A. Myasthenia Gravis and Crisis: Evaluation and Management in the Emergency Department. J Emerg Med. 2017;53(6):843-853.
Abel, Mark, and James B Eisenkraft. “Anesthetic implications of myasthenia gravis.” The Mount Sinai journal of medicine, New York vol. 69,1-2 (2002): 31-7.
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