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Myasthenia gravis (MG) is an autoimmune disorder characterized by antibody-mediated immunologic reaction striking the acetylcholine receptors. The anesthesia concerns for patients with MG include the disease state, drug interactions, and the anesthetic medications particularly the neuromuscular blocking agents (NMBAs). The anesthesia management in these patients is meticulous and requires appropriate execution of knowledge. Besides, such patient for off-pump coronary artery bypass surgery is quite uncommon; hence, we report this case.