Case reports Anaesthetic management of late onset Myasthenia gravis with fracture humerus, with undiagnosed thymoma.

late onset Myasthenia gravis with fracture humerus, with undiagnosed thymoma.

Abstract

Background: Myasthenia gravis (MG) is an autoimmune disorder characterized by fatigable weakness of skeletal muscles resulting from an antibody-mediated immunologic attack directed at acetylcholine receptors (or receptor-associated proteins) in the postsynaptic membrane of the neuromuscular junction.

Case Presentation: 62 years old, 86 kg male patient had road traffic accident and had blunt injury chest and fracture humerus. He was known case of MG, on treatment (Pyridostigmine and Prednisolone).He was scheduled for open reduction internal fixation(ORIF) proximal  humerus ( left side).Tailor made plan was made to minimise any adverse incident(myasthenia crisis).Further investigations revealed associated thymoma and immunosuppressant’s were started.

Conclusion: Patients with MG should be thoroughly investigated for associated thymoma. Regional anaesthesia with close monitoring is the key to successful outcome and avoidance of myasthenia crisis.