Background and Goal of Study:
Several anaesthetic techniques have been proposed for myasthenia gravis (MG) patients, although none has been proved to be better.1 The aim of our study was to compare general anaesthesia (GA) and regional anaesthesia (RA) in patients with MG regarding perioperative outcomes.

Material and Methods:
An observational retrospective study was conducted between May 2005 and August 2015. Patients with MG submitted to surgeries under GA and RA were included. Patient´s demographics and perioperative data were collected from medical records. Descriptive analysis was performed; Mann-Whitney U test, Fischer's exact test or Chi-square were used. Statistical differences were considered significant when p<0.05.

Results and Discussion:
A total of 50 patients were included corresponding to 68 surgeries: 17 under RA and 51 under GA. Patients submitted to RA were older than those submitted to GA (p=0.041). There were no differences in ASA physical status (p=0.08), body mass index (p=0.39) and duration of anaesthesia (p=0.83) between the two groups. Patients submitted to RA were predominately in stage I (69% vs 31%) and those submitted to GA had more often generalized form (78% vs 22%) (p=0.001). The RA group had longer LOS (p=0.016). None of the patients of LR group were admitted in ICU, while 25 patients of GA group were admitted.
Although patients from LR group had a mild form of disease, they were older and had longer hospital stay. This might be due to the type of procedure. The LR group consists of 11 patients, 6 of them was reoperated. Moreover, surgery was often skin grafts or related procedures, which often imply a longer hospital stay.
In this study 2 (2.9%) myasthenic crisis occurred, both after thymectomy under GA with use of NMB agents. There weren’t relation with length of MG (p=0.391), LOS (p=0.215) and ICU stay (p=0.822).

Conclusion(s):
 ASA physical status and MG’ grade didn’t determine the anaesthetic management. In our study patients submitted to LR anaesthetia were older and had a longer LOS but had more often a localized form of disease. Our results didn't allow us to conclude that one type of anaesthesia is superior to the other because of LR group were small and had important differences in relation to GA group.

References: 1 Acta Anaesthesiol Scand 2012; 56: 17–22

Does Regional Anaesthesia Improve Outcomes in Myasthenia Gravis Patients? - A Retrospective Study