why do we withdraw anticholinesterases in myasthenic crisis treatment? - USMLE Forums
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Old 11-07-2012
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Question why do we withdraw anticholinesterases in myasthenic crisis treatment?

Myasthenic crisis is treated with endotracheal intubation and withdrawal of anticholinesterases for several days.......

i don't get the rationale behind stopping of drugs since its due to exacerbation of MG...???????
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Old 11-08-2012
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In Myasthenic patient who treated with high dose of AchEI, muscles became insensitive to treatment leading to Cholenergic crisis, and you can confirm that by fail to improvement with Edrophonium test, so as part of treatment you should withdraw the AchEI for for days.

But if put Myasthenic patient under treatment he may develop Myasthenia crisis, and you can confirm that by improvement with Edrophonium test, so in this case you should increase the dose of anticholinesterases

May be this is right explanation
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Old 11-08-2012
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what u have written is certainly right...agree

but the idea of "not giving anticholinesterases" is confusing me.

myasthenic crisis is due to very low Ach at the nerve terminals leading to respiratory muscle weakness. so we must give the drugs to increase Ach levels at nerve terminals to overcome the crisis.....

may be they withhold just to be sure that the crisis is not due to drug overdose leading to receptor insensitivity....?????
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Old 11-08-2012
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In myesthenic crisis Treatment options are IVIG or plasmapheresis...

AchE has lesser effect in crisis...

More over crisis can also be due to over dosage of AchE..That may be the reason for temperory stoppage of AchE.


Harrisons Internal medicine
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Old 04-24-2013
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For the following reasons:
1- you are not sure if this is a myasthenic or an cholinergic crisis.
2- to prevent excess respiratory secretions while the patient is intubated
3- to prevent rebound cholinergic crisis when the patient recovers
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