Myasthenia gravis is a big deal to anesthesiologists

Myasthenia gravis is a disease that literally means "grave muscle weakness" and it has serious implications for anesthetic care. In this video, I explain why myasthenia gravis gets special attention from anesthesiologists, and how it can change anesthetic management.

0:00 Start
0:59 Myasthenia gravis
2:35 Paralysis in anesthesia
3:57 MG & paralytics
5:12 Reversal agents
6:07 Avoiding paralytics?

Music:

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional.

#Anesthesiology #Residency #MedicalSchool

[kristinreynolds]

I have MG that decided to bring cancer along for the party. There are very limited videos that talk about MG from a patient point of view. Anytime I have been in the hospital, I have told the doctors and nurses that if anyone has questions about MG to ask me. That’s the only way for people to learn and I’m more than happy to help in anyway I can. Thank you again for the video on MG!

[sheilastrait]

Now I understand why it’s important to be honest and truthful about your health conditions.

[emsheeren]

From someone with myasthenia gravis, thank you so much for making this video! It brings me some comfort knowing how truly knowledgeable anesthesiologists are. I’ve been under anesthesia countless times but it’s still always a little stressful with MG. I recently had a bad anesthesia encounter that left me with profound weakness upon waking up (and into the next day). We now know to have even more emergency medications and interventions ready in PACU as I wake up. Very glad to hear you guys are thoroughly educated on MG. Helps make these potentially scary and stressful situations feel a little easier.

[virginiagill]

As a person with MG I’ve had the great fun 🤪of having to stay awake during procedures because the anesthesiologists felt that between my MG and medication allergies it was too dangerous to put me all the way under. Thank you for helping to educate people!

[SueKenyon-jx]

Thanks for putting this together Max! Shout out to your dad for telling us about it 🙂 When I was first diagnosed, I had a thymectomy. My anesthesiologist did not take my MG and recent crisis into consideration. I was in "recovery" for over 24 hours and the surgeon wasn't sure I was going to wake up. I made sure that I personally speak to any anesthesiologist before surgery now. Once we are both comfortable - then we move forward. Congrats Dr Feinstein!!!!

[brianruane]

As an anaesthetist in the UK - this is a very sensible, logical commentary! It's clear to me this resident knows his stuff!! In 38+ years of anaesthesia practise, I have only ever intubated one female of 25 years age, who had a "respiratory crisis"....so actual experience with myasthenia is very limited but Ive been waiting all these years for such a patient to arrive on my list...(I'll be retiring soon..1)

[smoorej]

Thank you for making this video. I have MG and have luckily avoided this issue entirely by insisting on local anesthesia for operations including repair of a completely severed Achilles tendon (pre-arthroscopic, circa 1990) and repair of a torn medial collateral thumb ligament (“skiers thumb”). I realize there are times when general anesthesia is unavoidable but I was quite surprised at the reluctance of the surgeons to just use local. There was huge pushback but I explained that I have MG and that the best way to avoid complications is just to use local. The operations were uneventful; I was completely awake and chatting with the doctors. This experience convinced me that there are lots of surgeries that could be done under local but that, as one of my surgeons put it, “we prefer our patients to be asleep”.

[sandergoossens]

I am in my first year of studying medicine and I actually just learned this condition today for my exams... What a coincedence! Great video, keep it up.

[earthlightsmusic]

On a tangent, a friend who had oral cancer surgery was failing to recover from the paralytic and remained intubated while a workaround was sought, so she experienced being paralyzed and intubated and aware, all at once.

[swintondavid]

This is by far the most informative video for Myasthenia Gravis. I suffer a very difficult to manage generalised Myasthenia Gravis. Thank you 🙏

[reh]

I had a small procedure back in March and the anesthesiologist's eyes opened wide when I told him I have Lambert-Eaton Myasthenic Syndrome. All went well.

[maryrohr]

Thank you so much for bringing awareness to MG as a whole but also the anesthesia part of it. We appreciate you

[josephnield]

Fascinating video, thank you. My late father suffered from MG much of his life, and I've learned a lot about the condition over the years through my own research, but I learned some things here. I didn't realize neostigmine was used as an antiparalytic after anesthesia - if I recall correctly, it was one of the earlier pharmacological treatments for MG until a buffered form (Mestinon) came to market. Mestinon never did a lot for my dad, hence his heavy reliance on corticosteroids, which saved his life, but also hastened his death. My best to your loved one living with MG.

[mdarwin]

Hello Dr. Max I find your channel very educating and amazing. I started following your contents. I am a RN assigned on a medical and telemetry unit and learning alot from your medical videos. Thank you for sharing your medical knowledge. More subscribers to you Dr. Max. I hope meet you in person in NYC someday :)

[Teenibash]

I have MG and am waiting on an operation. It has been made clear to me about the difficulty with my anaesthetic.

[ballisticfox]

Excellent video! Recently got tested for MG which turned out to be negative, still extremely interesting to learn about these sorts of conditions.

[RobinHood]

In a similar vein, I'd be really interested to see a video on if/how you need to alter your approach for other conditions that affect the muscles, such as those that cause spasticity, rigidity, weakness, tremors, and so forth.

[sueellenware-ntst]

Dear Dr. Max,

I want to thank you so much for sharing your heart and your knowledge with me. You will bless so many!

I am an eight time Sero-Negative refractory, generalized Myasthenic since early childhood with PLEX being my main lifeline now. I also take Mestinon, Cellcept, and Prednisone. I am quite ill and chronically symptomatic.

In April 2023 I had an AV-Graft placed. The nerve block did not work so general anesthesia was opted for. Sometime during surgery my diaphragm failed. As the surgery was being completed, I awoke to my entire body spasming from head to toe. Once these muscle spasms stopped, my brain was awake and I was hearing everything being said between the doctors and nurses. YET, my body was completely paralyzed! I could not open my eyes, move my limbs, or speak. In my head I am SCREAMING "I'm here, I'm awake, I can hear you, PLEASE, PLEASE help me!" But noone could hear me. The body spasms continued which is one of my weird symptoms.

I awoke three days later in ICU, ventilated, and spasming . This was so incredibly frightening and physically devastating. I do not understand why this happened. Do Any thoughts? I am not asking for medical advice just needing to understand and mentally process the experience. My surgeon will not offer any insight.

I am truly grateful to you and your heartfelt respect, understanding, and support of Myasthenia Gravis.

If you do not mind, I will keep your loved one in my thoughts and prayers. God bless you and your wonderful career. You are a gem! 🦋

[starfishgurl]

I think my grandma had that before she died, or someone she knew, I can’t remember exactly who had it (it’s been 14 years since she died), I just remember them talking about it a lot and how it affected certain medication and treatment choices, I never realized how it could complicate surgeries but it makes perfect sense, thanks so much for explaining this!

[lizshoemaker]

My father is living with LEMS, and is a colon cancer survivor. It's difficult to treat. It was his ophthalmologist who first diagnosed him. He has good days, and bad days.