Myasthenia gravis: medical, surgical and anesthetic considerations.

Myasthenia gravis is usually defined as a chronic disease of the neuromuscular junction that has a disputed etiology . It is characterized by weakness and variable fatigue of voluntary muscles, symptoms that gradually are alleviated with rest. There is a predilection for ocular and other cranial muscles including those that control facial expression, swallowing, phonation and respiratory function. There may be limb muscle involvement which may lead to atrophy. The severity of the disease can range from mild (slight ptosis) to severe (complete respiratory failure), including death. There are no signs of neural lesion and partial reversability can be accomplished by the administration of cholinergic drugs. History Willis 3 first described the signs and symptoms of the disease in 1672. Erb, in 1879, described it again as ErbGoldflam's disease. In 1895, Jolly 5 named it myasthenia gravis pseudoparalytica. Campbell and Bromwell modified the name to myasthenia gravis in 1900. In 1934, Mary Walker 7 demonstrated that the administration of physostigmine was followed by marked improvement of muscle function. This was a landmark discovery that led to the present concept of myasthenia gravis as a malfunction of neuromuscular transmission.