Successful anesthetic management of two myasthenic patients using total intravenous anesthesia without muscle relaxants: A report of two cases

ABSTRACT

Myasthenia gravis (MG) is an autoimmune-mediated disease characterized by weakness and fatigability due to dysfunction of the neuromuscular junction from antibodies directed against the acetylcholine receptor (AchR). The main considerations for the anesthesiologist are the underlying muscle weakness and interactions with various anesthetic drugs. This includes sensitivity to neuromuscular blocking agents and volatile agents, and the risk of postoperative respiratory failure. We report two cases of transsternal thymectomy for MG under general anesthesia with the use of a bispectral index-monitored total intravenous technique using propofol and remifentanil without muscle relaxants.