title: Lambert-Eaton myasthenic syndrome during anesthesia: a report of 37 patients.
abstract: OBJECTIVE
  Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder of the neuromuscular junction that manifests with muscle weakness, autonomic and bulbar dysfunction, and increased sensitivity to neuromuscular blocking drugs. The objective of this study is to review perioperative outcomes on a series of patients with LEMS.
  
  
  METHODS
  The medical records of surgical patients with LEMS from January 1, 1990, to December 31, 2012, were retrospectively reviewed.
  
  
  METHODS
  Major academic hospital.
  
  
  METHODS
  Surgical patients with LEMS.
  
  
  RESULTS
  Thirty-seven patients underwent 60 surgeries, with most performed to diagnose or treat lung malignancy (n = 31; 51.7%). Equal number of patients had LEMS associated with small cell lung cancer (n = 16; 43.2%) or an autoimmune process (n = 16; 43.2%), with the remainder having various malignancies. Neuromuscular blocking drug medications were used in 23 (38.3%) of cases, including 8 patients who were not treated for LEMS symptoms. Four patients (11%) had respiratory complications. Interestingly, 3 patients were either undiagnosed or not treated for LEMS at the time of perioperative complication, and developed weakness after use of neuromuscular blocking drugs.
  
  
  CONCLUSIONS
  Patients with LEMS have increased sensitivity to neuromuscular blocking drugs. The risk for the development of prolonged muscle weakness or postoperative respiratory failure after being exposed to neuromuscular blocking drugs is increased in patients with undiagnosed or untreated LEMS.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address: weingarten.toby@mayo.edu.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Cadmar N
authors.initials: CN
authors.lastname: Araka
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Mogensen
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Sorenson
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Marienau
authors.affiliation: Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Watson
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D015624:Lambert-Eaton Myasthenic Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage* / Q000009:adverse effects; D009469:Neuromuscular Junction / Q000473:pathology*; D011183:Postoperative Complications / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000209:etiology / Q000601:surgery
chemical_list: D009466:Neuromuscular Blocking Agents
keywords: Anesthesia; Lambert-Eaton myasthenic syndrome; Peroperative complications