AANEM Connect
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Neuromuscular blockade in myasthenia gravis
Would appreciate advice regarding the use of paralytics in an 82 year old patient with a history of breast cancer and newly diagnosed AChR positive MG. She had transient diplopia prompting lab testing by opththalmology. She reports those symptoms were very fleeting and had not recurred but she was having balance impairment and burning in her thighs. On my exam she had medial rectus weakness with upgaze only, mild hip flexión weakness and hyperreflexia. C-spine demonstrated cord compression at C5-C6 and severe lumbar spinal stenosis at L3-L4. Unfortunately she has an FDG avid pulmonary nodule and needs an ION guided lung biopsied that requires a paralytic. Would suggammadex be reasonable given her low symptom burden? She is not currently on any immunosuppressive therapy or pyridostigmine.
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