Myasthenia gravis : towards a safer anesthesia technique clinical experience and review of literature

Abstract EN

Background / Aim : myasthenia gravis (MG) is a disease with many implications for the safe administration of anesthesia and involves considerable morbidity and mortality.

Thymectomy is a common surgical procedure in patients with myasthenia gravis.

Our aim is to provide a safe general anesthesia technique involving continuation of preoperative anticholinesterase, avoidance of muscle relaxants, use of short acting anesthetics, slow and cautious reintroduction of anticholinesterase after surgery, estuation on operating table and avoiding postoperative ventilation.

Patients and Methods : Eight patients underwent thymectomy from January 2003 to October use of non-paralyzing technique (i.e.

avoidance of muscle relaxants), and use of ultra-short acting anesthetics) Results : all our 8 patients who underwent trans-sternal thymectomy using the above technique were extubated on operating table following anticholinesterase and anticholinergic.

The ease of intubation was graded as "excellent" in 5 (62.5 %) patients and as "good" in 3 (37.5 %) patients.

Time to extubation after injection of neostigmine was 10±3 min.

There was no postoperative morbidity or mortality.

None of our patients needed ventilator assistance in the postoperative period.

Conclusion : this technique was safe and effective in all of our 8 patients who underwent trans-sternal thymectomy.

All our patients were extubated on table following administration of intravenous anticholinesterase and anticholinergic drugs.

There was no postoperative morbidity or mortality.

None of our patients needed ventilatory assistance in the postoperative period.