General anesthesia using supraglottic airway device in a myasthenic patient undergoing reverse shoulder arthroplasty

Myasthenia gravis (MG) is a neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The decrease in the number of acetylcholine receptors results in decreased efficiency of neuromuscular transmission. Although acetylcholine is released normally, it produces small end-plate potentials that fail to trigger muscle action potentials. Failure of transmission at many neuromuscular junctions results in weakness of muscle contraction. This also makes them susceptible to neuromuscular blocking agents which pose a challenge to the anesthesiologist. Here, we report a case of a patient who was a known case of MG posted for reverse shoulder arthroplasty, who was managed using a supraglottic airway device and spontaneous respiration.