Q: 34 year old male with long history of myasthenia gravis went for elective thymectomy. Inadvertently patient had blood loss of 2 liters. What would be your concern?
Answer: Postoperative myasthenic crisis
High Estimated Blood Loss (EBL), at least more than one litre itself is a risk factor for postoperative myasthenic crisis in patients with long standing myasthenia. Other risk factors are well known as low vital capacity, baseline need of high pyridostigmine dose or poor functional status.
Watanabe A, Watanabe T, Obama T, et al. Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis. J Thorac Cardiovasc Surg 2004; 127:868.