# Anesthetic Considerations in Congenital Myasthenic Syndrome: A Case Report

## TL;DR

This case report highlights anesthetic challenges in congenital myasthenic syndrome and suggests safe practices for managing these patients during surgery.

## Contribution

The report raises concerns about sensitivity to neuromuscular blocking agents and suggests safety of dilute local anesthetics in this patient group.

## Key findings

- Patients with congenital myasthenic syndrome may show heightened sensitivity to non-depolarizing neuromuscular blocking agents.
- Caudal administration of dilute local anesthetics appears safe for neuraxial analgesia in these patients.

## Abstract

Congenital myasthenic syndrome poses unique anesthetic challenges. Most notably, this rare disease is heterogeneous. Affected individuals’ responses to depolarizing and non-depolarizing neuromuscular blocking agents are poorly understood. Additionally, while neuraxial techniques may confer respiratory benefits due to their opioid-sparing profiles, it is unclear to what extent local anesthetics may impair signal transmission at the neuromuscular junction. This case report raises concern for heightened sensitivity to non-depolarizing neuromuscular blocking agents in patients with congenital myasthenic syndrome. Neuraxial analgesia with caudal administration of dilute local anesthetics appears to be safe.