Hi. I have myasthenia gravis. My past surgery hx is c-section w epidural, tubal ligation, thymectomy x2, bunionectomy, hernia repair, breast lift. I've never had any issues w general anesthesia.  On nov 20th, 2014 I went in for an abdominoplasty.  my BP is normally 90/75 and pulse runs 48-54. I take prednisone5 mg imuran 150 mg mestinon 60 mg , protonix 40 mg all of which I was instructed by pre op nurse to take morning of syrgery w small sip of water. When I was in pre op holding I was given a pepcid and I told the nurse I took protonix already an hour prior. She said take it anyway.   
Shortly after surgery began and hip to hip incision was made my BP dropped, pulse was in mid 20's per the monitors.  carotid pulse was not palpable but a faint radial pulse was.  Compressions were started, I was given atropine and taken across the street to the hospital ICU. LEG DOPPLERs, ct chest and heart ultrasound were dONE and all came back negative.  They told me I had a pulseless electrical activity and feel it was due to the mestinon as it can cause vasovagel episode. I cannot recall if I've took my mestinon the day of surgery in all
my previous surgeries.  My doctors feel I could go back to the OR to complete the procedure but I must not take the mestinon. Have you ever encountered this type of "chemical reaction" to anesthesia?  I am saddend I did not get my procedure done but thankful to be alive.  I've been on extremely high doses of prednisone since I was 17yrs old, (I'm now 44)gained a ton of wt and finally tapered to 5mg and lost 60lbs and have kept if off for 14 years but am left with a significant apron of skin.  Would you, as an anesthesiologist consider doing the anesthesia on a pt a second time after what happened?  Thank you in advance for your response and I apologize for the length of this email

It depends on what grade your MG is. If it is a milder form, then you can stop the Mestinon on the day of surgery. If it is a more serious type, then it is not recommended to stop. All that being said, you could certainly still have the procedure. Just make sure your anesthesiologist is aware of the problem you had on the previous surgery so s/he can take appropriate precautions. Your reaction is not typical and I can't say it is definitely related to the Mestinon or the MG but it is still important to make your anesthesiologist aware.

Ronald Levy, MD
Professor of Anesthesiology


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Ronald Levy, M.D.


Associate Professor of Anesthesiology, University of Texas Medical Branch at Galveston. I am a board certified anesthesiologist who can answer all questions related to any type of Anesthesia with the exception of Pain Management.

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