Extubation Failure in an Adolescent Patient after General Anesthesia for Gastrostomy Tube Placement

Myasthenia gravis (MG) is an autoimmune disease resulting in destruction of the post-synaptic nicotinic receptors at the neuromuscular junction. Classically, the earliest symptoms of MG are ocular, including ptosis and diplopia. Other less common early symptoms include dysphagia and fatigable chewing. Our case report describes the unusual presentation of MG in a teenager patient and presented for an elective percutaneous endoscopic gastrostomy (PEG), tube placement due to persistent weight loss. The patient underwent the procedure without any complications. At the time of tracheal extubation, she could not maintain spontaneous ventilation, so requiring mechanical ventilation. The patient was transferred from the recovery room to the pediatric intensive care unit (PICU). Subsequent investigations including a bedside electromyography (EMG), led to the diagnosis of MG. The patient was successfully extubated after treatment with intravenous immunoglobulin, oral prednisone 40 mg per day and pyridostigmine 60 mg every 8 hours.