Outpatient anesthesia for radiotherapy in a patient with myasthenia gravis. Case report

Abstract

BACKGROUND AND OBJECTIVES: Myasthenia Gravis (MG) is a rare autoimmune disease, characterized by the reduction in the number of nicotinic receptors in the neuromuscular junction, with an incidence of 14/100,000. The objective of this report is to describe the case of a patient with myasthenia gravis who underwent balanced general anesthesia for radiotherapy of a spinocellular carcinoma of the parotid gland as an outpatient. CASE REPORT: Male patient, 87 years old, 87 kg, physical status ASA III, with a prior history of myasthenia gravis; stroke; pacemaker for a third-degree AV block; and hypertension. He was scheduled for seven 20-minutes radiotherapy sessions under general anesthesia. In the radiotherapy room he was monitored with a cardioscope, noninvasive blood pressure, pulse oxymeter, and underwent general anesthesia with propofol and sevoflurane. After the induction, he maintained spontaneous ventilation with a Guedel canula and nasopharyngeal catheter with O2/sevoflurane for proper fitting of the immobilizing mask. He did not present any complications in the post-anesthetic recovery room. CONCLUSIONS: The choice of anesthetics and strict clinical followup allowed an elderly patient, with prior stroke and cardiopathy, to be submitted to balanced general anesthesia for radiotherapy, as an outpatient, with good response. © Sociedade Brasileira de Anestesiologia, 2006.