45yoF with myasthenia gravis presents in respiratory distress. She requires urgent intubation. Which paralytic will you use?
Myasthenia gravis is an autoimmune neuromuscular disorder in which antibodies target nicotinic acetylcholine receptors at the neuromuscular endplate, preventing excitation/depolarization and subsequent muscle contraction.
Respiratory compromise or failure may occur due to weakening of diaphragm/accessory muscles. In the ED this will be a clinical diagnosis, however on the INSERVICE you will identify spirometry, or more specifically, the negative inspiratory force, as the “next step” in management for pts with MG.
When intubating, we know one paralytic is supposedly contraindicated, but why? And is there data to support this contraindication?