Anaesthesia for trans-sternal thymectomy in myasthenia gravis

A retrospective review is presented of the thirty patients who underwent trans-sternal thymectomy for myasthenia gravis in our unit from 1980-85. The clinical status of these patients is contrasted to that of more severely debilitated patients described by other authors. The problems encountered by the anaesthetist in the perioperative care of patients with mild myasthenia gravis are discussed. Management of the perioperative anticholinesterase regime is described and a case presented for the use of suxamethonium for intubation. A less invasive postoperative regime is advocated in which tracheostomy and nasotracheal intubation are avoided, and anticholinesterase therapy is re-introduced orally as soon as possible after surgery.