Anesthetic management for a patient with myasthenia gravis undergoing coronary artery bypass graft

Report the clinical management of a patient having Myasthenia Gravis (MG), undergoing cardiopulmonary bypass (CPB).

A 71-yr-old man having MG (Osserman IIB), was admitted for coronary artery bypass graft (CABG) under CPB. Optimization of the patient was achieved preoperatively. Thymectomy was done following midsternotomy. Continuous monitoring of the neuromuscular transmission (NMT) was maintained throughout the perioperative period. The hemodilutional effect of CPB was counteracted by the hypothermia resulting in maintenance of cisatracurium requirements at the same levels as the prebypass period. Extubation of the trachea was done after ensuring adequate recovery of the NMT and respiratory function. Oral myasthenic therapy was resumed following extubation.

A myasthenic patient can safely undergo CPB provided adequate preoperative optimization is achieved. Continuous monitoring of the NMT must be throughout the perioperative period. Thymectomy is recommended in the myasthenic patient since it may improve the outcome. Extubation of the trachea is to be done after ensuring adequate NMT and respiratory function.