Myasthenia gravis is a disease of great importance to the anesthesiologist, because it affects the neuromuscular junction. Many patients with myasthenia gravis are treated by cholinesterase inhibitors for mild symptoms and advancing to immunomodulating medications for more severe weakness. Surgical thymectomy is an important line of treatment. A balanced technique of general anesthesia which includes the use of muscle relaxant can be safely used, provided neuromuscular transmission is monitored. Myasthenic patients are resistant to depolarizing relaxants but sensitive to nondepolarizing relaxants. Intermediate-acting nondepolarizing such as atracurium and vecuronium are eliminated rapidly, and can be titrated to achieve the required neuromuscular block that can be completely reversed at the end of surgery. Postoperatively, ventilator support may be required in high risk patient.