# Evaluation of swallowing function during the perioperative period using fiberoptic endoscopy in a patient with myasthenia gravis: a case report

## TL;DR

This case report shows how fiberoptic endoscopy can help monitor and manage swallowing issues in a myasthenia gravis patient during surgery.

## Contribution

Demonstrates the use of FEES for perioperative swallowing assessment in myasthenia gravis patients.

## Key findings

- FEES detected post-extubation swallowing impairments likely due to intubation and nasogastric tube.
- Swallowing function improved by postoperative day 1, indicating transient issues.
- No dysphagia specific to myasthenia gravis was observed.

## Abstract

General anesthesia causes postoperative dysphagia, and myasthenia gravis also impairs swallowing function. Thus, managing general anesthesia in patients with myasthenia gravis requires special attention to swallowing function. Fiberoptic endoscopic evaluation of swallowing (FEES) has the potential to provide precise perioperative assessment and management of swallowing in these patients.

A 35-year-old woman with myasthenia gravis was scheduled for laparoscopic ileocolic resection. FEES was performed before anesthesia, after extubation, and on postoperative day 1. General anesthesia was performed with endotracheal intubation, and extubation was performed uneventfully. Post-extubation FEES revealed salivary pooling, decreased glottal closure reflex, and redness of right arytenoid, likely caused by the endotracheal intubation and nasogastric tube. However, FEES performed on postoperative day 1 showed improvement of these findings.

FEES effectively identified transient swallowing impairments related to intubation and confirmed the absence of dysphagia specific to myasthenia gravis, thereby contributing to safe perioperative care.