LEMS and Anesthesia

Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disease that affects the connection between nerve and muscle cells. Patients’ bodies produce antibodies that mistakenly attack this connection, and the muscles grow weak as a result. The abnormalities in nerve signaling mean that patients may have an atypical response to anesthesia.

What is anesthesia?

Anesthesia medications can either prevent nerve cells from sending pain signals to the brain or render patients completely unconscious. The mechanisms by which these medications work are still largely unknown. Most anesthetics belong to one of two groups: local and general.

Local anesthetics numb a particular region of the body, preventing you from feeling pain or other sensation in that region. You may need local anesthetics for minor operations such as dental procedures or getting stitches, for example.

General anesthetics are those that put patients in an unconscious state. This is usually not one medication, but a combination of several that work together. The “cocktail” of anesthetics generally include a neuromuscular blocking agent to prevent involuntary movement during surgery and muscle relaxants. People may need general anesthesia for more serious dental procedures such as having their wisdom teeth removed or larger surgical procedures such as having an appendix removed.

What problems can anesthesia cause for people with LEMS?

People with LEMS may respond more strongly to anesthesia than people without the disease. This can mean the effect of local anesthetics may last for longer.

General anesthetics, which often include medications such as muscle relaxants, may slow breathing to dangerous levels in LEMS patients.

What precautions should doctors take?

Complications are rare, as long as your anesthesiologist is aware you have LEMS and can take precautions. These will include monitoring you more closely during the procedure and adjusting the dosage of the medication to levels that are safer for you.

As a LEMS patient, you may also need a recovery room at the hospital for a longer period of time because you may feel weak for longer.

Last updated June 22, 2020

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