Patients with myasthenia gravis are particularly sensitive to which type of neuromuscular blocking agents?

Patients with myasthenia gravis have a compromised neuromuscular junction due to the presence of antibodies that block or destroy nicotinic acetylcholine receptors. This condition leads to muscle weakness and fatigue, which can be exacerbated by the use of neuromuscular blocking agents during surgical procedures or anesthesia.

Nondepolarizing neuromuscular blocking agents work by competitively blocking the action of acetylcholine at the neuromuscular junction, preventing muscle contraction. In patients with myasthenia gravis, where there is already a reduced number of functioning receptors, the administration of these agents can lead to profound and prolonged neuromuscular blockade. The sensitivity to nondepolarizing agents is particularly concerning, as a small dose can lead to significant respiratory muscle weakness and difficulty in recovering from anesthesia.

While depolarizing agents, such as succinylcholine, also affect the neuromuscular junction, their mechanism of action is different. They cause depolarization of the motor end plate and can briefly stimulate muscle contraction before leading to paralysis. In patients with myasthenia gravis, the response to depolarizing agents can be unpredictable. Their use is often avoided because they can result in an exaggerated response and