LEMS and Anesthesia

[Ashley Gregory]

Good morning all!

I know I’ve touched briefly on anesthesia considerations for LEMS/Myasthenic patients. I recently found two articles that are pretty informative.

To sum it up, patients with LEMS and myasthenia in general should not be given “neuromuscular blockers” or in simpler terms, paralytics.

Using a paralytic in surgery, will increase the time we take to wean off a ventilator because we are extra sensitive to them due to our calcium channel antibodies.

If you are interested in reading the full articles, you can check them both out!

The first one is published in The Continuing Education in Anaesthesia Critical Care & Pain Journal at Oxford and the other was in the Journal of Clinical Anesthesia

Have you had surgery after your LEMS diagnosis? Or even before diagnosis when you were experiencing LEMS symptoms?

If so, I’d love to hear about your experiences.

[Price Wooldridge]

Both of my two most recent surgery procedures, Medi-port placement and pacemaker implant, have not required full anesthesia. I’ve been awake…mostly. The two drugs used were versed and propofol. Neither are paralytic. Though it would be nice to be asleep under full anesthesia, I do like the much easier and shorter recovery time, allowing me to go home same day within an hour or two.

[Ashley Gregory]

Hi @kiseki

Propofol is a drug used for anesthesia, however it’s also used for moderate sedation. General anesthesia is a combination of Propofol (to induce anesthesia) followed by anesthetic gases which keep you asleep.

As far as I know, there is no problem with Propofol for LEMS patients, (most of us have the same antibodies). I have had surgery 3 times with no issues since my LEMS diagnosis. The only medication that could cause issues for patients with myasthenia is paralytics, which aren’t always used and can be avoided in most cases.

Hope this helps!

[Eleanore Monty]

A heartfelt thank you! This is so very helpful.

I am bringing myself quickly up to speed  – it’s quite something to educate a team of  physicians why have never dealt with LEMS!

We believe that Wes has had the disease for 1 1/2 years , but it was masked in throat cancer diagnosis, treatment, a grand mal seizure after COVID shots, encephalitis, sepsis, bleeding ulcer etc etc etc. When he was in hospital for 19 weeks Oct – Dec, I requested an autoimmune test which revealed the voltage gate . . . however we were never given results. Consequently when he was ambulanced into hospital on 2/14 – his heart rate and blood pressure, oxygen so low he was a noodle, placed in ICU again. This is when they began treating LEMS with 5 days of IVIG, prednisone and imuran. He just had another IVIG yesterday. He will receive 1 treatment per month as a precaution.  He is improving and we are cautiously optimistic.

He is cancer free but will receive quarterly scopes and scans. Onward and upward.

I have other questions but will post them in the proper format.

Again a sincere thank you!!!

[Ashley Gregory]

Hey @emonty

I’m so glad you found this helpful!

I’m so happy to also hear that Wes is cancer free and he was able to get a diagnosis (even though it took some time) and get started on IVIG!

@pricewool and I receive monthly IVIG as well! Let us know if you have any questions about that too!

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