• Indication usually Myasthenia Gravis (see "Myasthenia Gravis" page for more detail):

    • Risks: aspiration, perioperative respiratory failurecholinergic or myasthenic crises

    • Treatments: immune suppression, plasmapheresis, pyridostigmine

    • Altered response to neuromuscular blocking drugs (NMBs):

      • ​Sensitive to NdMR (nondepolarizing muscle relaxants) and resistant to succinylcholine

  • Anterior mediastinal mass considerations (see "Anterior Mediastinal Mass" page for more detail)

  • Postoperative analgesia for median sternotomy

  • Potential need for lung isolation to improve surgical exposure





  • Preoperative assessment & optimization of myasthenia gravis patients: preoperative plasmapheresis, multidisciplinary discussion

  • Minimize risk of aspiration

  • Minimize risk of perioperative respiratory failure (judicious use of NMBs & opioids; epidural analgesia)

  • Minimize risk of myasthenic or cholinergic crisis

  • Discuss surgical approach with surgeon & need for lung isolation

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