Anesthetic Management of a Patient With Myasthenia Gravis Undergoing Thoracoscopic Thymectomy: A Case Report and Literature Review

Myasthenia gravis is an autoimmune neuromuscular disorder characterized by fluctuating skeletal muscle weakness and fatigability.Perioperative management is challenging because patients may have bulbar or respiratory muscle involvement and altered sensitivity to neuromuscular blocking agents, increasing the risk of postoperative respiratory failure and myasthenic crisis.Thymectomy is an established therapeutic option in selected patients with myasthenia gravis and may be performed using minimally invasive thoracoscopic techniques.We report the anesthetic management of a 48-year-old man with generalized acetylcholine receptor (AChR) antibody-positive myasthenia gravis (MGFA class IIb) scheduled for thoracoscopic thymectomy.The patient had a recent relapse with diplopia, dysphagia, and easy fatigability, which improved after medical therapy.Preoperative optimization included intravenous immunoglobulin therapy for four days.General anesthesia was induced with propofol and remifentanil without initial neuromuscular blockade.Tracheal intubation was facilitated using video laryngoscopy after topical lidocaine.Anesthesia was maintained with sevoflurane, and invasive monitoring was established.Because of the surgical requirement for improved thoracoscopic visualization, a reduced dose of rocuronium was administered intraoperatively under train-of-four monitoring.At the end of surgery, neuromuscular blockade was reversed with sugammadex, and the patient was successfully extubated and transferred to the intensive care unit in stable condition.This case highlights the importance of careful preoperative optimization, avoidance of neuromuscular blocking agents when possible, quantitative neuromuscular monitoring, and individualized use of low-dose rocuronium with sugammadex reversal when muscle relaxation is required during thoracoscopic thymectomy in patients with myasthenia gravis.