Perioperative management of patients with myasthenia Gravis: prevention, recognition, and treatment

Myasthenia gravis (MG) is an autoimmune disease characterized by weakness and fatigability of skeletal muscles, with improvement following rest. The disease was so named because of a frequently fatal outcome. As recently as 30 years ago, 25% of patients with MG died of the disease. Treatment advances have dramatically changed the expected outcome, and with appropriate therapy, most patients with MG can now lead normal lives and have a relatively normal life expectancy. In this article we review the pathophysiology of MG, its signs and symptoms, treatment, the perioperative evaluation and preparation for surgery, and the anesthetic consideration to enable clinicians better understand this disease entity and provide guidance in diagnosis and care of patients with MG.