Bradycardia, hypotension and bronchospasm following remifentanil-propofol in a myathenic paitent treated by pyridostigmine--a case report.

Myasthenia Gravis is an autoimmune neuromuscular disorder of skeletal muscles due to the presence of acetylcholine receptor antibodies. Myasthenic patients are resistant to depolarizing relaxants such as succinylcholine but are very sensitive to non-depolarizing muscle relaxants1. That’s why, narcotic-based technique for induction and maintenance of anesthesia without muscle relaxants has been recommended in myasthenic patients undergoing thymectomy2. The present report shows that total intravenous anesthesia using a combination of remifentanil-propofol can precipitate severe bradycardia, hypotension and bronchospasm in a myathenic patient receiving pre-operative pyridostigmine therapy up to the morning of surgery.