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 

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