[Can one use high thoracic epidural analgesia in postoperative intensive care of the myasthenia patient following trans-sternal thymectomy?].

Analgesia is an important problem in myasthenia gravis patients who have undergone transsternal thymectomy. Postoperative pain interferes with pulmonary function, which is already limited by the disease. The choice of medication is restricted because many analgesics are synergic to the myasthenia gravis syndrome and detrimental to the patient. Three patients with severe myasthenia gravis are presented who had undergone transsternal thymectomy with good postoperative results. They received high thoracal epidural anesthesia (C7-Th1/Th1-Th2/Th2-Th3) with a solution of bupivacaine and morphine (20 ml 0.25% bupivacaine with 10% morphine). The patients were extubated in the first 48 hours and monitoring of respiratory function (CV2, PO2, PCO2) showed satisfactory values. With this type of analgesia we obtained early mobilization and good patient cooperation. Although limited this favourable experience confirms that high thoracal epidural anesthesia is a sure technique which allows rapid weaning from the ventilator and maximum comfort for the patient. It avoids the use of other medication or analgesics which are contraindicated in these patients.