#35931 Regional anaesthesia for intubation and maintenance in myasthenia gravis patient with bilateral renal calculi

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Background and Aims

30year old male patient weighing 40kg with a known case of myasthenia gravis was posted for right percutaneous nephrolithotomy and left open urethrolithotomy. Patient had a muscle power of 3/5, hence we wanted to avoid skeletal muscle relaxant to the patient.

Methods

Patient was shifted to operation room, monitors connected, IV cannula established. Anterior neck area was disinfected with surgical spirit. – Bilateral superior Laryngeal nerve block given using 2ml of 2%lignocaine + 2ml of 0.5%bupivacaine. – Translaryngeal block given using 1ml of 2%lignocaine + 1ml of 0.5%bupivacaine. – 2 sprays of 10%lignocaine spray was administered in the posterior pharyngeal area. Later epidural was established at L1-L2. After test dose, epidural was activated with 10ml of 0.5% bupivacaine. BIS monitor was connected. Inj. Dexmedetomidine was administered 40mcg IV over 10 minutes. The patient was preoxygenated for 3 minutes and later Induced with Inj. Propofol 80mg IV. Once BIS was <60, patient was intubated using 7.0 cuffed endotracheal tube and fixed at 21cm. The endotracheal tube cuff was inflated with 5ml of 1%lignocaine to prevent intubation related complications during extubation process.

Results

If BIS>80, Inj. Propofol 20mg IV bolus was given. BIS was maintained around 60 intraoperatively. Patient was maintained intraoperatively by O2: Air = 0.5l:2l. Inj.Propofol at 160 to 320mg/hr, Inj. Dexmedetomidine at 10 to 20mcg/hr and epidural infusion was maintained with 4 to 6ml of 0.25%bupivacaine. Post-Operative patient was extubated the next day in ICU.

Conclusions

Airway block helped in successful management of myasthenia gravis patient without skeletal muscle relaxant for successful surgery.