Combination of balanced and regional anaesthesia for minimally invasive surgery in a patient with myasthenia gravis

A 45-year-old man with cryptorchism, who was known to suffer from generaliz ed myasthenia gravis, was admitted to hospital for surgical treatment using laparoscopy. Such minimally invasive surgery requires good muscle relaxati on. However, the use of neuromuscular blocking agents in patients with myas thenia gravis may lead to prolonged apnoea after operation, thus necessitat ing mechanical ventilation of the lungs. We used a combination of general a naesthesia (with desflurane), and epidural anaesthesia (with the amide loca l anaesthetic ropivacaine) to obtain excellent abdominal relaxation during surgery. Tracheal extubation was possible immediately after the operation a nd no adverse effects were observed. The patient was discharged from hospit al on the second day after operation. The combination of regional and gener al anaesthesia for minimally invasive surgery in this patient permitted saf e anaesthetic management.