Perioperative cardiac risks in myasthenia gravis.

Myasthenia gravis (MG) is an autoimmune disorder that affects the neuromuscular junction. The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors (AChRs), which results in qualitative and quantitative reductions in the availability of functional AChRs. Cardiac muscles are also affected, resulting in various perioperative cardiac complications. Antistriational antibodies are commonly reported in MG cases with cardiac involvement. In the presence of thymoma, the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%. Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia, myocarditis, conduction disorders, heart failure, and sudden death. Increased incidence of atrial fibrillation, ventricular and supraventricular extra systoles, and prolonged QTc have also been reported in patients with MG. Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.

Pitfalls in internal jugular vein cannulation.

Central venous catheter insertion in the internal jugular vein (IJV) is frequently performed in acute care settings, facilitated by its easy availability and increased use of ultrasound in healthcare settings. Despite the increased safety profile and insertion convenience, it has complications. Herein, we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.

Myasthenia Gravis for Spine Surgery: An Ardous Anaesthetic Journey.

Myasthenia gravis (MG) is a neurological disorder involving the post-synaptic neuromuscular junction and is caused by the autoimmune destruction of acetylcholine receptors with ensuing muscular weakness. Rarely is the disease process in MG compounded with other comorbidities and distinctive surgical challenges, such as the prone position in spine surgery, presenting unique challenges in the anesthetic management of such cases. This case series and the ensuing discussion describe the successful perioperative management of two cases of MG undergoing neuro-surgical management for lumbar spine pathologies.