Abstract
English
Highlights
Myasthenia gravis is a disease affecting the nicotinic acetylcholine receptor of the post-synaptic membrane of the neuromuscular junction, causing muscle fatigue and weakness
We have described a safe and effective strategy for anaesthesia in this unusual patient with concomitant myasthenia gravis
We report a case of Myasthenia gravis (MG) and PCC, two anaesthetically challenging conditions co-existing in the same patient, and discuss the anaesthetic considerations and management during the surgical resection of PCC
Summary
Myasthenia gravis (MG) is a neuromuscular disorder with antibodies against the post-synaptic nicotinic acetylcholine receptor at the neuromuscular junction, decreasing the ability of the neuromuscular endplate to transmit nerve signal, causing muscle weakness. Case report A 74-year-old lady, 172 cm, 48 kg, presented with a background history of hypertension, diabetes mellitus, hyperlipidemia, small perimembranous ventricular septal defect and ocular MG Her MG has been stable on pyridostigmine 120 mg tds. TOF tested with a peripheral nerve stimulator was 4 with no fade 3 h after the muscle relaxant was given at induction with no top-up dose subsequently She was breathing spontaneously, she appeared to be weak clinically (her hand grip strength was diminished); we decided to keep the patient intubated till she was served her usual dose of pyridostigmine. The postoperative course was complicated by complete consolidation-collapse of her right lung lower lobe and partial collapse of right lung middle lobe, requiring re-intubation on POD 3, IV antibiotics, mucolytics and intensive chest physiotherapy She was extubated 3 days later and discharged from hospital stable on POD 14. Twenty-four-hour urine collection repeated in the outpatient setting was normalised
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