Myasthenic crisis is a state being cunable to maintain an open airway free of secretions and (or) adeguate ventilatory exchange because of failing musclar function. Nowadays the management is composed of respiratory care, the administration of cholinesterase or short-term administration of corticotropin or corticosteroid. In this case complicated with aspiration pneumonia, tracheostomy with the use of a cuffed tracheostomy tube, assisted respiration and the intramuscular administration of neostigmine and pyndo stigmine were enforced.