Perioperative Approach in a Patient with Myasthenia Gravis

Saimir Kuci; Alfred Ibrahimi; Shaban Memeti; Marsela Goga; Selman Dumani; Ali Refatllari

doi:10.3889/oamjms.2021.7002

Authors

Saimir Kuci Department of Cardiac Anesthesia, Mother Teresa University Hospital Center, Tirana, Albania https://orcid.org/0000-0002-6869-4120
Alfred Ibrahimi Department of Cardiac Anesthesia, Mother Teresa University Hospital Center, Tirana, Albania
Shaban Memeti University Clinic of Paediatric Surgery, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Marsela Goga Department of Cardiac Anesthesia, Mother Teresa University Hospital Center, Tirana, Albania
Selman Dumani Department of Cardiac Surgery, Mother Teresa University Hospital Center, Tirana, Albania
Ali Refatllari Department of Cardiac Surgery, Mother Teresa University Hospital Center, Tirana, Albania

DOI:

https://doi.org/10.3889/oamjms.2021.7002

Keywords:

Thymecomy, Myasthenia gravis, Neuromuscular disorder

Abstract

Background: Myasthenia gravis is an autoimmune neuromuscular disorder that causes the destruction and overall decrease in functional acetylcholine receptors at the neuromuscular junction. The resultant respiratory and cardiovascular implications are a primary cause of mortality; therefore, a complete and comprehensive understandings of this disorder is vital for the anesthesia provider. Anesthesia management in myasthenia gravis is a great challenge for all anesthesiologists. In this disease, even small doses of muscle relaxants could lead to delayed recovery for respiratory muscles.

Case report: We present the case of a 38 years old woman (weight 87 kg) diagnosed with Myasthenia Gravis, which symptoms has worsened recently. The case demonstrates the anesthetic challenges involved, with a focus on the overall approach, pharmacologic considerations, physiological changes, and an emphasis on preoperative operative and post-operative optimization.

Conclusion: Thymectomy is a common procedure performed in cases of myasthenia gravis (MG) with a thymoma or general MG that does not improve with medical therapy. During anesthesia the use of propofol or sevoflurane with opioids without the use of any neuromuscular blocking agents has been used with success.

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