Anesthesia Considerations 

Myasthenic (Eaton-Lambert) Syndrome

 

 

Background 

 

• Autoantibodies are directed against presynaptic voltage-gated calcium channels

• ↓ release of acetylcholine

• Frequently associated with cancers (paraneoplastic syndrome) 

 

 

Considerations 

 

• Muscle weakness predisposing to respiratory failure after anesthesia; potential need for post-op PPV 

• Associated with lung carcinoma 

• Extremely sensitive to both succinylcholine & NdMRs (nondepolarizing muscle relaxants)

• Autonomic dysfunction present in 30% 

 

 

Optimization 

 

• Counsel & prepare for postop PPV/ICU 

• IVIG prep may help ↑ muscle strength  

 

 

Goals 

 

• Minimize use of neuromuscular blockers, optimize postoperative ventilation status

• Regional anesthesia preferred to general anesthesia if possible