The Role of Sugammadex in Symptomatic Transient Neonatal Myasthenia Gravis

Safety and efficacy of sugammadex in management of patients with myasthenia gravis undergoing general anesthesia: A systematic review

Objective

The objective of this study was to analyze available evidence on efficacy and safety of sugammadex in reversing neuromuscular blockades in patients with Myasthenia Gravis (MG), thereby providing a comprehensive understanding of its potential benefits and risks in this specific patient population.

Methods

We performed a systematic search for studies from PubMed, Embase, Web of Science, and Google Scholar. Sources were screened using Rayyan, following predefined inclusion and exclusion criteria focusing on English articles published from 2010 to 2024 on MG patients under general anesthesia. Data on patient characteristics and outcomes were extracted, and quality was appraised using the JBI Critical Appraisal Checklist.

Results

Out of 361 initial citations, 24 studies met inclusion criteria. Sugammadex demonstrated rapid and effective reversal of neuromuscular blockades, with ToF recovery times ranging from 79.7 s to 10 min, and short extubation times. The incidence of postoperative myasthenic crisis was low, and no mortalities were reported.

Conclusion

Sugammadex may serve as a reasonable option for the reversal of neuromuscular blockades in MG patients, indicating potential for rapid recovery and a relatively low incidence of serious complications. However, due to the limited number of studies and the nature of the evidence available, further large-scale and rigorous investigations are warranted to better establish its superiority over traditional reversal agents.

Transient Neonatal Myasthenia Gravis as a Common Complication of a Rare Disease: A Systematic Review

Myasthenia gravis (MG) is a rare autoimmune disease. Transient neonatal myasthenia gravis (TNMG) is caused by pathogenic maternal autoantibodies that cross the placenta and disrupt signaling at the neuromuscular junction. This is a systematic review of this transient immunoglobulin G (IgG)-mediated disease. TNMG affects 10-20% of children born to mothers with MG. The severity of symptoms ranges from minor feeding difficulties to life-threatening respiratory weakness. Minor symptoms might go unnoticed but can still interfere with breastfeeding. Acetylcholine-esterase inhibitors and antibody-clearing therapies such as immunoglobulins can be used to treat TNMG, but most children do well with observation only. TNMG is self-limiting within weeks as circulating antibodies are naturally cleared from the blood. In rare cases, TNMG is associated with permanent skeletal malformations or permanent myopathy. The mother's antibodies can also lead to spontaneous abortions. All healthcare professionals meeting pregnant or birthing women with MG or their neonates should be aware of TNMG. TNMG is hard to predict. Reoccurrence is common among siblings. Pre-pregnancy thymectomy and intravenous immunoglobulins during pregnancy reduce the risk. Neonatal fragment crystallizable receptor (FcRn) blocking drugs for MG might reduce TNMG risk.