Patients with suspected myasthenia gravis may be posted for diagnostic tests like tensilon test. Such patients may pose unique concerns during the procedure. 34-year female presented in the opthalomology clinic with complaints of drooping of eyelids. Etiology of this symptom was suspected to be myasthenia gravis. For confirmation she was posted for tensilon test. In the operating room, after attaching routine monitors, intravenous access was secured. Papillary aperture was noted. 0.5 mg of neostigmine was administered to see its sensitivity. Then 2 mg of neostigmine was administered intravenously. Soon after, fasciculations were observed through out the body and nystagmus was noted. Patient complained of severe retching followed be vomiting. Four mg of ondansetron was given intravenously. The pupillary aperture increased indicating improvement in the muscle power thus confirming the diagnosis of myasthenia gravis.
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