OPTIMIZED TOTAL INTRAVENOUS ANESTHESIA USING PROPOFOL AND DEXMEDETOMIDINE IN A MYASTHENIA GRAVIS PATIENT UNDERGOING ERCP: A REFLEX SUPPRESSION AND CARDIAC STRATEGY

A 75-year-old female with Oserman Grade IIb Myasthenia Gravis, ischemic heart disease, and multiple comorbidities underwent ERCP under general anesthesia using a carefully tailored total intravenous anesthesia technique with propofol and dexmedetomidine. Preoperative optimization, continuation of pyridostigmine and steroids, and local airway topicalization with lidocaine ensured reflex suppression and avoided the need for neuromuscular blocking agents. Anesthesia was induced and maintained with propofol and dexmedetomidine, with spontaneous ventilation preserved and hemodynamics stable throughout. The patient emerged smoothly, was extubated awake, and had an uneventful recovery and same-day discharge. This case highlights the feasibility of non-relaxant TIVA in MG patients needing airway instrumentation,balancing reflex control, cardiac safety, and respiratory function [1,5].