A 70-year-old male patient with myasthenia gravis required coronary artery bypass grafting due to triple-vessel disease. The anesthetic management was performed with general anesthesia using reduced doses of muscle relaxants. He was extubated four hours after surgery and the postoperative course was uneventful. Coronary artery bypass surgery in myasthenic patients can be challenging to anesthesiologists and cardiac surgeons. In this rare condition, a meticulous assessment of the patient's neurologic and cardiac status, and careful perioperative anesthetic management were needed in order to avoid life-threatening complications in both intraoperative and postoperative periods.
Note: On 26th October, the author 'A. Agrawal' was corrected TO 'S. Agrawal'.Myasthenia gravis is a disease of great challenge to the anesthesiologist, because it affects the neuromuscular junction. Anesthetic management involves either muscle relaxant or non-muscle relaxant techniques. This case report documents the safe use of fentanyl, propofol and sevoflurane combination guided by bispectral index, without the use of muscle relaxants in a patient with myasthenia gravis who presented for meningioma surgery.Kathmandu University Medical Journal Vol.13(1) 2015; 80-82
Myasthenia gravis, a disorder of neuromuscular transmission, presents a unique challenge to the perioperative anesthetic management of morbidly obese patients. This report describes the case of a 27-year-old morbidly obese woman with a past medical history significant for myasthenia gravis and fatty liver disease undergoing bariatric surgery. Anesthesia was induced with intravenous agents and maintained with an inhalational and balanced intravenous technique. The nondepolarizing neuromuscular blocker Cisatracurium was chosen so that no reversal agents were given. Neostigmine was not used to antagonize the effects of Cisatracurium. The goal of this approach was to reduce the risk of complications such as postoperative mechanical ventilation. The anesthetic and surgical techniques used resulted in an uneventful hospital course. Therefore, we can minimize perioperative risks and complications by adjusting the anesthetic plan based on the patient’s physiology and comorbidities as well as the pharmacology of the drugs.
Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy
