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Myasthenia gravis (MG) is a disease affecting the neuromuscular transmission. Patients show various and unpredictable sensitivity and response to non-depolarizing muscle relaxants. The risk of residual muscular blockade and postoperative respiratory failure with consequent complications is very high in such patients. An essential part of the MG treatment, namely if there is a thymoma present (10-15% of cases), is surgical thymectomy. Full thymectomy by partial sternotomy is the gold standard surgical treatment thereof. Our case report depicts a peri-operative course in a 45 years old woman with BMI of 28.3 kg/m² and myasthenia gravis grade IV according to the Osserman classification. The farmacological treatment and plasmapheresis were ineffective. During two years she suffered two myasthenic crises requiring mechanical ventilation. Instead of thymectomy by partial sternotomy, a videothoracoscopic thymectomy was performed. Prior to surgery she had late symptoms of chronic respiratory insufficiency with dyspnoea even in the sitting position. Appropriate choice of short acting and well-controlled drugs used for general anaesthesia, desflurane included, contributed to smooth surgery and rapid, full recovery. Desflurane contributes to safe and effective general anaesthesia in patients suffering from severe stage of myasthenia gravis. [ABSTRACT FROM AUTHOR]