A COMBINED REGIONAL ANESTHESIA-BASED OPIOID-SPARING APPROACH FOR THYMECTOMY IN A PATIENT WITH MYASTHENIA GRAVIS: A CASE REPORT
DOI:
https://doi.org/10.67214/5n0mvf81Keywords:
myasthenia gravis, sternotomy, superficial parasternal blockAbstract
Introduction: Anesthesia for patients with Myasthenia Gravis requires carefully tailored anesthetic strategy, to minimize the risk of potentially fatal postoperative respiratory failure. A novel regional technique, the superficial parasternal intercostal plane block provides a safe and effective adjunct to combined general anesthesia, which can help reduce perioperative complications.
Case presentation: We report a case of successful anesthetic treatment of a 20-year-old female with Myasthenia Gravis that underwent thymectomy with mid-chest skin incision and sternotomy. The operation was performed under a combined general anesthesia protocol that anticipated strict avoidance of benzodiazepines and muscle relaxants with a decrease in the total dose of opioids. The patient was induced with propofol, fentanyl (50mcg), and remifentanil infusion. Sevoflurane and low-dose remifentanil infusion provided adequate hypnosis and sufficient relaxation during the operation. After the endotracheal intubation, we performed a modified bilateral superficial parasternal intercostal plane block, which, in combination with a low-dose remifentanil infusion, provided optimal analgesia that persisted throughout the postoperative period. The patient was extubated in the operating room and resumed spontaneous breathing without any respiratory complications. Postoperatively, according to the Visual Analog Scale at 4 time points (T1 – after the operation, T2 – 6 hours, T3 – 12 hours, and T4 – 24 hours), the patient reported minimal or no pain.
Conclusion: The implementation of a regional technique in this case facilitated multimodal analgesia, reduced the overall opioid requirement, and contributed to faster patient recovery. This case highlights the importance of meticulous, individualized planning tailored to the patient’s needs in order to achieve favorable outcomes.
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