Myasthenia gravis is a big deal to anesthesiologists 

I have been that way once. It was so scary and frustrating.

What is the problem with that syndrome ?

@@alexdenton6586 sensitivity to NDMRs, aka paralytic. Aka much nicer and easier to reverse the effects and get the OP breathing on his own again using sugammadex instead of glyco+neo (assuming he was tubed idk he said small procedure so maybe not). But basically what his syndrome is, is his body struggles to release ach (responsible for muscle contractions) due to defective pre-synaptic calcium channels. As a result people with lambert eaton tend to wake up very weak but get stronger as the day goes on (as those less effective channels are working all day eventually the ach builds up in the synapse and they feel stronger)

@@alexdenton6586😂 he knew he needed a lot of coffee for that one

A lot of the time it just comes down to experience of the surgeon/anesthesiologists. Some do spinals, peripheral blocks and/or local anesthetic blocks for basically every single patient whom those arent contraindicated for(whether they’re doing it awake or going under GA-all the above are great for intraop and post op pain management for normal patients as well so they help decrease the amount of opioids needed). Where as some surgeons/anesthesiologists basically never do blocks bc they arent comfortable performing them due to lack of experience with it. Really comes down to training and how comfortable they are doing them tbh. Unfortunately for tendon surgeries, bc the surgeon needs to stretch the tendon. They need muscld paralysis bc it basically makes the muscle flaccid and thus is easier for them to stretch and reattach. Meaning they either have to do what you had done, which is a local block at they level of the surgery where the local anesthetic blocks action potentials to the msucle fibers (thus giving the same flacid paralysis effect) or you have to be tubed under GA with muscle relaxant on board (which MG pts are sensitive to so anesthesia generally dont want to paralyze yall unless they have to). Now a days local and peripheral blocks are far more common thanks to better and better ultrasound machines (and training on newer docs).

For the most part its: use and LMA or a MAC and keep them spontaneously breathing the entire case if you cand. If not; if its a bigger procedure and you have to put a breathing tube in and paralyze then you want to use low dose MR’s amd just run them very deep (instead of using the MR to primarily keep them from moving use your gases/narcs/propofol to do so). Then use sugammadex to reverse rhe MR. In cases like people with MG you basically want to keep them spontaneously ventilating without a tube because if they meet whats known as leventhals criteria bc if they do then its more likely than not they will have to remain intubated in PACU until they’re deemed strong enough to remove the tube.

Some medical conditions that cause weakness you have to avoid certain drugs like muscular dystrophy, multiple sclerosis, etc. It depends on the condition and as a rule of thumb less is more when giving anesthesia. A lot of serious neuromuscular conditions can increase risk of acid reflux/aspiration too.

So its more likely the issue wasnt the propofol(propofol is actually one of our friends for MG pts, bc its one of the options we have in our pocket if we want/have to decrease the amount of paralytic we use-its referred to as running a deep anesthetic, basically we load up on more gas/propofol/narcotic and this can blunt your motor reflexes like how muscle relaxant does, but it does so outside the perview of the neuromusuclar junction where muscle relaxant works/MG exists) . The issue you had was more likely the paralytic used/how much/what they reversed the paralytic with/did they give you any other drugs that we routinely give that potentiate(prolong) the effects of paralytic . Bc it was laparoscopic surgery you were almost assuredly tubed and then given a muscle paralytic so they could get up under your abdominal muscle layer without those muscles tensing up/spasming. Problem is MG pts are SUPER sensitive to the muscle relaxants we give known as NMDRs. Meaning you want to run lower dosing than you would for a normal patient. Likely the second surgery they went heavier on the paralytic, you’re more sensitive to it(you require less for the same effect thus the excess was just sitting there waiting for its turn to work). Idk what reversal agents they gave or how much, you likely still had some on board which helped contribute to your feeling of weakness. The NMDRs we give block ach release pre synaptically, im sure you know this, how do we treat your MG while awake? You take a drug that helps increase your ach in the synapse in order to overcome your decreased amount of ach receptors. Thus if our NMDR is still semi-active and blocking the ach release into the synapse, you now have fewer receptors and less ach and thus the profound weakness you felt.

I also have double sero-negative MG too. Since the diagnostic antibody tests were negative, my daughter took a video when my face and eyes were acting up for the neurologist to diagnose me.

@@allieg4011 Hopefully your diagnosis enables you to receive treatment, even though options are limited for seronegative MG

Oh no, was it problems with surgery? 😬 I also have MG and lifelong asthma!

@@kristinasnowflake Diaphragmatic involvement in combination with medical staff not really knowing what they were up against. Took a while (actually) ongoing to get asthma treatment optimised under the circumstances.

@@jneill Ugh that's awful, I'm sorry!

@@kristinasnowflake It sucked. I'm still pretty damn furious about the whole thing. Hellooo, YOU are the doctors, you should be able to manage this, there should be adequate inter-clinical communication (which is what failed spectacularly). It shouldn't have to be me googling to find that damn 90per cent oxygen sats is not good and I don't think that this is an asthma flare-up.

New ASA guidelines basically mirror that sentiment.

I hate neostigmine sugammadex is wonder drug

@@MaxFeinsteinMD Is the drug becoming cheaper as it's utilization grows?

sugammadix

Does that still interfere with mestinon

Chemo , Cyclophate, just finished (6 month) , am in partial remission , except for legs (literature says Cyclophate remission is good for 9 months in 75%, up to about 4 years, with 1/22 being in remission 10+ years)

No. MS has no association to the receptors described in this video.

There are other anesthesia considerations for MS patients. Ie: you cant get a spinal for pain relief. But your considerations are different from that of MG

I imagine that it will

@@MaxFeinsteinMD do you think it could eliminate direct laryngoscopy from anesthesia training?

And which one do you use more frequently?

@@zpr6815 i dont think it will (anytime soon atleast) eliminate it from training. Bc in the cases of needed to emergently intubate someone, you may not have a cmac or a glidescope in the room and thus still need to know how to do good old fashioned DL with a mac/miller blade.

That's what I believe as well. Thanks! 😀

Opiod addiction/dependence tends to be time-dependent, intra-operative doses or even very short courses for post-operative pain will not lead to dependence/addiction.

What ^ said, but also spinals, peripheral nerve blocks, and local anesthetic blocks are becoming more and more common place as to help anesthesia and the PACU nurses decrease the amount of opioids they deliver for pain responses through out a case as well.

Same thing just happened to my Uncle. Supposed to be quick cataract procedure and now it's been many months and they've finally agreed to do it local anesthesia instead. Have you got yours done yet?

Thats wild. Maybe he was joking around? Idk anesthesiologists can be goofy. Good news is most of the concerns for MG pertain to muscle relaxant and paralytic. For a colonoscopy those arent gonna be used unless the patient cant maintain their airway or isnt trusted by the care to to maintain the airway. Which is usually only the case in the endoscopy suite if the patient is massively obese (talking 350+) or has some form of airway trauma/mass.

Love sketchy!

👀👀👀

No. 3 weeks!

Congratulations in advance, Max!

@@MaxFeinsteinMD ❤️

Calm down, Ramses II.

Ok