[General anesthesia for diaphragmatic herniorrhaphy in a patient with myasthenia gravis and severe gibbus].

We experienced a case of diaphragmatic herniorrhaphy complicated with myasthenia gravis (MG) and gibbus. A 66-year-old woman was scheduled for diaphragmatic herniorrhaphy. She had a 10-year history of MG graded Osserman classification IIA. She had received prednisolone and pyridostigmine. After epidural catheter insertion into T 6-7 interspinal space, anesthesia was induced with sevoflurane 5% and maintained with sevoflurane 1%, nitrous oxide 3 l x min(-1) in oxygen 3 l x min(-1) and epidural block using 1% mepivacaine. Surgery was completed in 75 minutes. She was extubated without any complications 45 minutes after the end of surgery. Using muscle relaxant in this case with MG and gibbus might place her under artificial ventilation after surgery. For diaphragmatic herniorrhaphy adequate muscle relaxation is necessary. Thus, we used sevoflurane and epidural block. We successfully anesthetized a patient for diaphragmatic herniorrhaphy complicated with myasthenia gravis and gibbus by sevoflurane and epidural block.