[Problems of anesthesia for cesarean section in myasthenia gravis]

The case of a 27 year old female, being pregnant the second time and suffering from myasthenia gravis since 1974 is reported. The patient was admitted to the hospital for repeat caesarian section. Anaesthesia of the preoxygenated patient during caesarian section was induced with 0.5% halothane and ketamine (2 mg/kg b.w.) intravenously. Muscle relaxing drugs (competitive and depolarizing inhibitors) as well as morphine derivates (e.g. fentanyl) and barbiturates are contraindicated. Therefore anaesthesia was maintained with 0.2:N2O = 1:1 combined with 0.5% halothane up to the point of ligation of the umbilical cord, and up to 1.5% halothane thereafter. Intubation was performed without muscle relaxation. The postoperative somnolence frequently seen after the combined use of ketamine and halothane was antagonized with physostigmine salicylate. The newborn showed all signs of neonatal myasthenia.