What precautions must be taken for surgical procedures that require general anesthesia in patients with Myasthenia gravis and LEMS

What precautions must be taken for surgical procedures that require general anesthesia in patients with Myasthenia gravis and LEMS? 

Delayed recovery from neuromuscular blocking agents must be anticipated in both LEMS and Myasthenia gravis.

Nondepolarizing, short-acting neuromuscular blockers at minimal necessary doses are preferred.

Intravenous steroids equivalent to oral maintenance doses should be given until oral steroids can be resumed.

An additional bolus during surgery may also be helpful.

Anticholinesterase therapy is usually unnecessary during surgery but is started postoperatively as needed when the patient regains consciousness.

The differences between parenteral and oral doses of anticholinesterase should be recognized.

Maintain normal serum electrolytes, calcium, phosphorus, and magnesium.

Avoid unnecessary medications to minimize drug-related complications, especially those that may worsen neuromuscular transmission 

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