[Remifentanil-based anaesthesia in a patient with myasthenia gravis].

Background: Anaesthesia of a patient with myasthenia gravis requires special preoperative management and proper choice of intraoperative agents. The disease should be treated until surgery and some anaesthetics (e.g. barbiturates, benzodiazepines) eliminated. Moreover, the choice of opioids providing suitable intraoperative analgesia is relevant.

Case Report: We present a case of a 68-year-old male patient, ASA II, with the 10-year history of myasthenia gravis scheduled for glaucoma surgery. Premedication was not administered. Anaesthesia was induced with fentanyl and propofol. After endotracheal intubation, anaesthesia was maintained with the mixture of N(2)O and O(2) (1:2), the infusion of propofol and remifentanil. Remifentanil was administered in iv continuous infusion in the dose of 0.04 microg kg(-1) min(-1) followed by 0.08 microg kg(-1) min(-1). Muscle relaxants were not used. Anaesthesia was uneventful, except for transient bradycardia (HR-43 min(-1)). The patient recovered 5 min after surgery and was extubated after the further 3 min. No postoperative muscle weakness and respiratory failure were observed.

Discussion: Surgical treatment of a patient with myasthenia may intensify adverse manifestations of the disease. To provide safe anaesthesia, muscle relaxants should be avoided and remifentanil used. The onset of action of this selective opioid receptor agonist is rapid and its residual activity short-term. Remifentanil ought to be the drug of choice in patients with myasthenia gravis.