Sevoflurane anesthesia in a myasthenic patient undergoing transsternal thymectomy

Myasthenia gravis (MG) is an autoimmune disease resulting from the production of antibodies against the acetylcholine receptors of the neuromuscular synapse. The thymus gland is involved in the autosensitization process, and there is a consensus that all adults with generalized MG should have a thymectomy. Removal of a much thymic tissue as possible via the transsternal approach in the logic goal of thymectomy in the treatment of MG. Because of the unpredictable response to succinylcholine and the marked sensitivity to nondepolarizing muscle relaxants in the MG patients, some anesthesiologists avoid the use of muscle relaxants in the myasthenic patients, and depend on deep inhalation anesthesia, such as halothane, isoflurane or sevoflurane. In the present report, we used sevoflurane 4%, without supplementation by muscle relaxants, for the induction and maintenance of anesthesia in a MG patient undergoing transsternal thymectomy. The report reviews the anesthetic technique, and describes the electromyographic (EMG) changes following sevoflurane.