Anesthesia for thymectomy in Myasthenia Gravis

Abstract

Myasthenia gravis is a chronic autoimmune disorder of neuromuscular transmission in which acetylcholine receptor antibodies attack the postsynaptic membrane of the neuromuscular junction leading to fluctuating but progressive weakness and easy fatigability of voluntary skeletal muscle, with improvement following rest. The process most likely originates in the thymus. Thymectomy improves the cause of disease and can increase the remission rate. Anaesthesia in patients with myasthenia. Gravis is one of the greatest challenges for an anaesthesilogist. To achieve the proper preoperative evaluation and preparation, intraoperative monitoring and management, and postoperative care, the anaesthesiolgoist must be aware of the pathophysiology of disease and the pharmacology of the patient treatment and drugs used per operatively. Our experience of anaesthesia in thirty patients of myasthenia Gravis undergoing thymectomy over a period 20 months is being presented here. Propofol was used for induction of anaesthesia and endotracheal intubation. Anaesthesia was maintained with IPPV with OZ, N,O 50% each and halothane 0.5-1% . No muscle relaxant was used low dose of intravenous opioids was used for analgesic and all patients were extubated on the operation table. Recovery was rapid after completion of transternal thymectomy. Reversal (neostigmine+atropine) was given before extubation even though no muscle relaxant was used. Patients were shifted to ICU postoperatively. No patient required postoperative ventilation of lungs. Postoperatively. Diclofenac Sodium 75mg LM 8 hourly was used for analgesia.