{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T19:44:14Z","timestamp":1789328654804,"version":"build-2803163510"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Some individuals with subclinical myasthenia gravis (MG) are positive for serum anti-acetylcholine receptor antibodies, without neurological symptoms. There are no anesthetic management guidelines for subclinical MG. We report the anesthetic management of a patient with subclinical MG who underwent a thymectomy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 57-year-old female with subclinical MG was scheduled for an extended thymectomy. Anesthesia was induced and maintained with mainly propofol and remifentanil. We administrated the minimum amount of rocuronium with reference to train-of-four (TOF) monitoring when a neuromuscular relaxant is needed. Although the prolonged effect of rocuronium was observed, the TOF ratio had already recovered to 100% before the tracheal extubation. Postoperative analgesia was performed by a continuous epidural infusion of levobupivacaine.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>We reported the anesthetic management of a patient with subclinical MG who underwent a thymectomy. Further research is necessary to clarify subclinical MG patients' sensitivity to rocuronium.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40981-022-00541-4","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T01:02:46Z","timestamp":1657846966000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anesthetic management of a patient with subclinical myasthenia gravis who underwent a thymectomy: a case report"],"prefix":"10.1186","volume":"8","author":[{"given":"Satoshi","family":"Uchida","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiko","family":"Kudo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Takekawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyoshi","family":"Hirota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"541_CR1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1111\/j.1399-6576.2011.02558.x","volume":"56","author":"L Blichfeldt-Lauridsen","year":"2012","unstructured":"Blichfeldt-Lauridsen L, Hansen BD. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand. 2012;56:17\u201322.","journal-title":"Acta Anaesthesiol Scand."},{"key":"541_CR2","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1186\/s13019-020-01320-x","volume":"15","author":"C Liu","year":"2020","unstructured":"Liu C, Liu P, Zhang XJ, Li WQ, Qi G. Assessment of the risks of a myasthenic crisis after thymectomy in patients with myasthenia gravis: a systematic review and meta-analysis of 25 studies. J Cardiothorac Surg. 2020;15:270.","journal-title":"J Cardiothorac Surg."},{"key":"541_CR3","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.lungcan.2020.12.010","volume":"152","author":"F Marcuse","year":"2021","unstructured":"Marcuse F, Hochstenbag M, Hoeijimakers JGJ, Hamid MA, Damoiseaux J, Maessen J, et al. Subclinical myasthenia gravis in thymomas. 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Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients. Can J Anaesth. 2003;50(6):547\u201352.","journal-title":"Can J Anaesth."},{"key":"541_CR7","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1016\/j.bja.2017.11.106","volume":"120","author":"LH Lundstr\u00f8m","year":"2018","unstructured":"Lundstr\u00f8m LH, Duez CHV, N\u00f8rskov AK, Rosenstock CV, Thomsen JL, M\u00f8ller AM, et al. Effects of avoidance or use of neuromuscular blocking agents on outcomes in tracheal intubation: a Cochrane systematic review. Br J Anesth. 2018;120:1381\u201393.","journal-title":"Br J Anesth."},{"key":"541_CR8","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1111\/j.1365-2044.2009.06236.x","volume":"65","author":"C Unterbuchner","year":"2010","unstructured":"Unterbuchner C, Fink H, Blobner M. The use of sugammadex in a patient with myasthenia gravis. 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