Anesthetic management of myasthenia gravis patient undergoing laparoscopic cholecystectomy using proseal laryngeal mask airway

Myasthenia Gravis is an autoimmune disease characterized by weakness and fatiguability of skeletal muscles, with improvement following rest. It may be localized to specific muscle groups or it may be generalized. The incidence of myasthenia gravis is cited as 50 to 142 cases per 1 million and women in the age group of 20 - 30 yrs are most commonly affected. It is a chronic autoimmune disorder characterized by a decrease in acetylcholine receptors at the neuromuscular junction secondary to their destruction or inactivation by circulating antibodies. Patients are at an increased risk of pulmonary aspiration because of pharyngeal and laryngeal muscle weakness, and they may present with dysphagia, dysarthria and an overall difficulty of handling secretions. In this case report, we describe a patient with myasthenia gravis undergoing laparoscopic cholecystectomy using a proseal laryngeal mask airway without the use of muscle relaxant.