Perioperative Management in the Myasthenia Gravis Patient Exhibiting Postoperative Myasthenic Crisis: A Case Study

This case study examines the perioperative management of a patient with Myasthenia Gravis (MG) who developed postoperative myasthenic crisis following an emergent exploratory laparotomy converted to a Hartmann's procedure evidenced by respiratory failure requiring mechanical ventilation, hypertension, and tachycardia despite appropriate reversal of neuromuscular blockade with sugammadex after rocuronium administration. A review of the literature highlights the limitations of standard RSI dosing and reliance on twitch monitoring alone in MG patients, as well as other factors such as the exacerbating effects of fluoroquinolones like ciprofloxacin, stress of surgery, and possible infection. A review of the literature also suggests that neuromuscular blocker-free total intravenous anesthesia (TIVA) with remifentanil may be a safer alternative in this population. This case underscores the importance of individualized anesthetic plans, careful medication selection, and heightened vigilance in patients with MG to prevent postoperative complications.