Case report of simultaneous coronary artery bypass grafting with cardiopulmonary bypass and total thymectomy in patient with myasthenia gravis

In this article we want to describe the successful simultaneous operation of coronary artery bypass grafting with cardiopulmonary bypass and thymectomy in patient with ischemic heart disease and myasthenia gravis. Myasthenia gravis complicates the course of anesthesia and operation, because of the inadequate restoration of muscle function, especially of respiratory and swallowing muscles, inducing the prolonged mechanical ventilation, gastrooesophageal reflux and pulmonary infection. There are lot of different techniques of the anesthesia during myasthenia gravis - no use of any myorelaxantes, restriction of opioids, use an inhalation anaesthetics and propofol, and continuous monitoring of neuromuscular junction function. Till now it is discussable question of necessity and the time of thymectomy. This case from clinical practice shows, that the correct choice of tactics of pre- and postoperative treatment makes simultaneous coronary artery bypass grafting with cardiopulmonary bypass and thymectomy possible.