Unexpected Myasthenic Crisis in Anesthesia for Magnetic Resonance Imaging - Diagnosis and Management.

Abstract

Myasthenic crisis (MC) is a rare and life-threatening manifestation of myasthenia gravis (MG) and is characterized by rapidly progressing weakness of respiratory and bulbar muscles leading to immobility, severe dyspnea, respiratory insufficiency, and possible aspiration. Early recognition and prompt treatment may prevent the development of further complications and the need for intubation, invasive mechanical ventilation, and ICU admission. Its diagnosis requires a high degree of clinical suspicion, and anesthesiologists, despite being prepared to deal with and provide anesthesia care to patients with MG, may not be immediately aware of the correct diagnosis and treatment of this medical emergency, and of the red flags that should promptmore invasive measures. Due to the very low incidence and possibly high morbidity of the condition, it is important to report cases of perioperative MC to raise awareness forearly diagnosis and treatment.This case also emphasizes the importance ofpre-anesthetic consultationand a multidisciplinary approach with appropriate communication and referral between medical specialtiesas the diagnosis of MG was not disclosed to the anesthetic team. The organizational, communication andsafety gaps that occurred during the perioperative periodcould potentially have had a negative impact on patientoutcomes. We report a case of MC in a patient who underwent general anesthesia for ambulatory magnetic resonance imaging and whose diagnosis of MG was not conveyed to the anesthesia care team.