Prevalence of Postoperative Complications in Myasthenic Patients: About 30 Cases

Abstract: Myasthenia gravis is an autoimmune disease responsible for weakness and fatigue of the skeletal musculature. It is more common in women. The objective of our study is to highlight the perioperative management modalities for thymectomy for myasthenia gravis. We conducted a retrospective descriptive study of patients who underwent thymectomy for myasthenia gravis in the central operating room of Ibn Tofail Hospital in Marrakech between January 2022 and March 2025. Treatment is based on anticholinesterases and immunosuppressants. During acute attacks, none of our patients required intravenous immunoglobulins or plasma exchange. The thymus is responsible for triggering and maintaining autoimmunization in all our patients. In our study, perioperative management was multidisciplinary, with preoperative assessment of various severity scores based on the Osserman and Leventhal scores, which modified the patterns of anesthetic agent use (particularly neuromuscular blocking agents). In most cases, the postoperative course was uneventful, comparable to a normal population. However, the risk of postoperative complications is documented and primarily concerns respiratory function. In our series, postoperative respiratory complications were not recorded. Nevertheless, all our patients operated on under general anesthesia were extubated on the table; extubation occurred after complete reversal of the neuromuscular block for patients in whom neuromuscular blocking agents were used. Postoperatively, a 24- to 48-hour intensive care stay was routinely required for all patients for postoperative monitoring. Myasthenic treatment was systematically resumed 6 hours after the end of the procedure. In our series, all our patients remained stable during their post-operative stays in intensive care, whether they were patients in whom curare was used or those in whom curare was not used.