A patient with myasthenia gravis requires abdominal surgery. Which neuromuscular blocking agent strategy is MOST appropriate?

• A Normal doses of succinylcholine; avoid non-depolarizing agents
• B Standard doses of rocuronium with neostigmine reversal
• C Succinylcholine infusion throughout the case
• D Greatly reduced doses of non-depolarizing agents with neuromuscular monitoring; avoid succinylcholine ✓

Explanation

Patients with myasthenia gravis have a reduced number of functional nicotinic acetylcholine receptors due to autoimmune antibody-mediated destruction, making them exquisitely sensitive to non-depolarizing muscle relaxants — doses 1/10th to 1/5th of normal may produce profound blockade. Conversely, they are relatively resistant to succinylcholine (the Phase I block is attenuated) but may develop Phase II block unpredictably. Non-depolarizing agents in reduced doses under continuous neuromuscular monitoring with sugammadex available for reversal is the safest approach.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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