Anaesthetic management for a case of thymectomy in a patient with myasthenia gravis – A Case Report

Abstract

Myasthenia gravis is characterized by autoantibody attack of acetylcholine receptors at the motor end plate of striated muscles. Anaesthetic implications include respiratory failure, delayed postoperative extubation. Markedly higher sensitivity to muscle relaxants is observed in this group of patients which can exacerbate these complications. Hence proper and optimal planning of intraoperative management is important.

CASE REPORT:

A 51 year old male diagnosed with Myasthenia Gravis posted for Thymectomy. On pre anaesthetic evaluation , patient revealed history of oral Pyridostigmine and oral Glycopyrrolate therapy since 2 years. Thoracic epidural was secured to alleviate the surgical pain due to sternotomy. Patient was premedicated with Inj. Glycopyrrolate 0.2mg IV, Inj. Midazolam 2mg IV, Inj. Fentanyl 100mcg IV. Patient was induced with Inj. Propofol 140mg IV. Patient was then intubated with 8.0mm I.D flexometalic tube. Maintenance of anaesthesia was done with oxygen, nitrous oxide, Sevoflurane (MAC: 1.7), Inj. Fentanyl Infusion (20mcg/ml; rate of 20ml/hr) Inj. Propofol (10mg/ml; rate of 30ml/hr). Invasive and non invasive haemodynamic monitoring was achieved, along with temperature monitoring. Complete awake extubation with Inj. Sugammadex 200mg IV was done.

CONCLUSION:

The patient with Myasthenia Gravis was successfully managed under general anaesthesia without the usage of neuromuscular blockade and optimal monitoring along with thoracic epidural for management of post operative analgesia and extubated without any untoward complications.

Keywords: Myasthenia gravis, anaesthesia, thymectomy