Ketamine-Dexmedetomidine Sedation in the Management of a Child With Generalized Refractory Myasthenia Gravis and Respiratory Insufficiency: Case Report

Myasthenia gravis (MG) is a rare autoimmune disease characterized by muscle weakness and fatigability that can be generalized with respiratory muscle involvement. The anaesthetic management of these patients poses significant challenges not only because of the nature of the disease and its possible interactions with anaesthetic drugs but also because of the risk of developing a life-threatening myasthenic crisis. We report the case of a child with generalized refractory MG and pneumonia, worsening his chronic respiratory insufficiency, proposed for an urgent thoracocentesis and chest drain placement, that was successfully managed under sedation with ketamine and dexmedetomidine, allowing to avoid a general anaesthesia, preserve the patient's respiratory drive, and protect his airway. The present report highlights the potential applicability of this novel drug association in MG patients, regarding its safety and efficacy in maintaining respiratory drive and haemodynamic stability in these patients.