A combination of total intravenous anesthesia and thoracic epidural for thymectomy in juvenile myasthenia gravis


Dr O. Bagshaw, Department of Anaesthesia, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK (email: oliver.bagshaw@bch.nhs.uk).


Juvenile myasthenia gravis is the acquired form of the disease in children and presents with ocular signs, fatigability, weakness and bulbar problems. The majority of patients demonstrate thymic hyperplasia and have been shown to benefit from thymectomy. The main considerations for the anesthesiologist are the degree of muscle weakness, the muscle groups involved and sensitivity to neuromuscular blocking drugs and volatile agents. Total intravenous anesthesia (TIVA) with epidural analgesia is probably the anesthetic technique of choice, although the latter is often avoided, because of the risk of a very high block. Two cases of thymectomy are presented where anesthesia was provided using a combination of TIVA and thoracic epidural analgesia. Both patients tolerated the technique well and had an uncomplicated perioperative course.