HPE HPE 85 – Spring 2017 - Page 52

Practical therapeutics apomorphine as profound hypotension can be induced. MG MG is an autoimmune neuromuscular disorder characterised by fatigable weakness of skeletal muscle. MG ranges from purely ocular symptoms, to generalised weakness that can progress, sometimes rapidly, to myasthenic crisis where diaphragmatic and intercostal weakness results in respiratory failure. Consequently there should always be a low threshold for anaesthetic and neurology involvement. Symptomatically, MG is managed by anticholinesterase drugs but immunosuppressive treatment is often required to address the underlying autoimmune pathology. Steroids are the first-line immunosuppressive therapy and the history of steroid exposure should be verified to identify the potential for hypothalamic–pituitary axis suppression and the need for perioperative supplementation. Azathioprine and mycophenolate are commonly used as steroid-sparing agents to control MG. Their effects on the immune system are such that short-term omission of a few doses is unlikely to be detrimental. 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