Preparing for Surgery When You Have Myasthenia Gravis

Medical Disclaimer: This content was created for generalized informational purposes only. This is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

People with myasthenia gravis (MG) may require or choose to get surgery that is not related to their MG and wonder whether it is safe.

Elective Surgery is best performed when symptoms of MG are stable. This helps reduce the likelihood of severe breathing difficulties after surgery, known as myasthenic crisis. This can be triggered by the stress of surgery, anesthesia, and other factors.

You should have a complete evaluation by your neurologist before scheduling any surgery. Ideally, surgery should be scheduled early in the day when myasthenia symptoms are typically the least severe.

What do I tell the surgeon?

You should tell your surgeon and anesthesiologist that you have a diagnosis of myasthenia gravis. They will ask you detailed questions about your MG including your treatment history, types of symptoms, and whether you have had a myasthenic crisis in the past. This information will help them determine the safety of surgery and anesthesia.

Is anesthesia safe?

For patients who require general anesthesia, it is ideal to avoid neuromuscular blocking agents (NMBAs), although this is not always possible. Your surgeon and anesthesiologist will determine the best anesthesia plan for you and will monitor you closely before, during, and after surgery.

Will I have to stop taking my medications?

Acetylcholinesterase inhibitors (pyridostigmine), steroids, and other long-term immunomodulating therapies (azathioprine, methotrexate, mycophenolate, cyclosporine, cyclophosphamide, tacrolimus, rituximab) can be continued up to the day of surgery.

However, some patients may need extra doses of steroids before or after surgery - this will be determined by your surgeon

Will I need to take an antibiotic?

Your surgeon will determine whether you need to take antibiotics before or after surgery. In general, some antibiotics may worsen symptoms of myasthenia gravis, including:

• aminoglycosides
• polymyxins
• ampicillin
• macrolides
• tetracycline
• fluoroquinolones

Talking to your doctors and surgeon ahead of time can help you prepare for a successful and safe surgery.