EPIDURAL-ANESTHESIA IN A PATIENT WITH MYASTHENIA-GRAVIS

We present a patient with myasthenia gravis who was safely managed by epidural anesthesia during and after thymectomy. An epidural catheter was inserted via the C7-T1 intervertebral space and 2% lidocaine was u sed during the surgery. The level of analgesia as determined by pinpri ck extending from C5 to T6. Epidural morphine or morphine and bupivaca ine were used for postoperative pain relief. We evaluated ventilatory responses to CO2 and hypoxia after epidural anesthesia with lidocaine or morphine, and during continuous epidural infusion of the mixture of morphine and bupivacaine. Ventilatory responses to CO2 and hypoxia we re both depressed following epidural injection of morphine. However, d epression of ventilatory responses was not demonstrated following cont inuous epidural infusion of a mixture of morphine and bupivacaine. Thi s case report suggests that epidural anesthesia is useful as a primary anesthetic and for postoperative pain control in patients with myasth enia gravis.