Muckler Virginia C, O'Brien Jennifer M, Matson Stephen E, Rice Andi N
J Perianesth Nurs. 2019 Feb;34(1):4-15. doi: 10.1016/j.jopan.2018.03.009. Epub 2018 Jul 3.
Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease in which antibodies against the post-nicotinic acetylcholine receptor at the neuromuscular junction develop. Although the exact cause of MG remains unknown, the thymus is a common factor in many cases. Patients with underlying junctional disease, such as MG, have greater anesthesia-related risks because of their known predisposition toward prolonged muscle weakness. Medications given in the perioperative period, such as anesthetic agents, antibiotics, cardiovascular drugs, and corticosteroids, affect neuromuscular transmission that contributes to muscle weakness. Judicious use of neuromuscular blocking agents for patients with MG must be considered. This patient population is at high risk for respiratory failure, and therefore must be carefully assessed throughout the perioperative period to ensure that a regular spontaneous respiratory pattern is sufficient to provide adequate oxygenation. Perianesthesia providers must consider anesthetic, ventilatory, and pharmacologic implications when proposing, providing, and recovering anesthesia for the patient with MG.
重症肌无力（MG）是一种慢性自身免疫性神经肌肉疾病，其中会产生针对神经肌肉接头处烟碱型乙酰胆碱受体的抗体。尽管MG的确切病因尚不清楚，但胸腺在许多病例中是一个共同因素。患有潜在接头疾病（如MG）的患者，由于其已知的发生持续性肌无力的倾向，具有更高的麻醉相关风险。围手术期使用的药物，如麻醉剂、抗生素、心血管药物和皮质类固醇，会影响神经肌肉传递，进而导致肌无力。必须考虑为MG患者谨慎使用神经肌肉阻滞剂。该患者群体发生呼吸衰竭的风险很高，因此在整个围手术期必须仔细评估，以确保规律的自主呼吸模式足以提供充足的氧合。围麻醉期医护人员在为MG患者提议、实施和恢复麻醉时，必须考虑麻醉、通气和药理学方面的影响。
