Abstract:

Introduction: Lambert–Eaton myasthenic syndrome (LEMS), with an incidence of 2–3 
cases per 1,000,000 individuals and also known as Eaton–Lambert syndrome, is an autoimmune 
disorder of the neuromuscular junction in which the immune system targets presynaptic voltage
gated calcium channels. This results in impaired release of acetylcholine, thereby disrupting the 
ability of nerve cells to transmit signals to muscle cells. The condition leads to a gradual 
progression of muscle weakness and autonomic nervous system dysfunction. In approximately 50
60% of cases, LEMS is a paraneoplastic syndrome, most commonly associated with small-cell lung 
carcinoma. Patients with LEMS undergoing anesthesia exhibit increased sensitivity to both 
depolarizing and non-depolarizing neuromuscular blocking agents and are at increased risk of 
perioperative respiratory complications, with a potential need for postoperative mechanical 
ventilation. 
Aim: Based on a real clinical case treated in the intensive care unit of Life Hospital, to discuss the 
challenges from the perspective of anesthesiology and intensive care management in patients with 
LEMS. 
Materials and Methods: A detailed analysis of the available medical literature concerning the 
problems encountered in patients with Lambert–Eaton myasthenic syndrome (LEMS) was 
conducted, along with an analysis of the anesthetic and intensive care considerations in such 
patients. The specific features of the presented clinical case were also examined. 
Conclusion: Lambert–Eaton myasthenic syndrome represents a significant challenge for 
anesthesiology and intensive care due to altered neuromuscular transmission, high sensitivity to 
neuromuscular blocking agents, and progressively worsening muscle weakness. Successful 
management of these patients requires careful preoperative planning, close monitoring, and an 
individualized anesthetic approach, as well as precise decision-making regarding the need for 
mechanical ventilation during the period of intensive care. 

Keywords: Lambert–Eaton myasthenic syndrome, myasthenic syndrome, anesthesiology, intensive 
care, neuromuscular transmission. 

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