Introduction: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease manifesting with weakness and fatigue of skeletal muscles after physical exercise, with a tendency to subside after periods of rest and typically after taking anticholinesterase medication. Myasthenia gravis is characterized by autoantibody attack of acetylcholine receptors at the motor end plate of striated muscles, which results in variable muscle weakness made worse by exercise.

Hydatid cyst the larval cyst stage of the tapeworms Echinococcusgranulosus and E. multilocularis, containing daughter cysts with many scoleces.

Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver,alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis.

Case report : A 56 years old male patient admitted in surgical ward, with Compliants of passage of dark coloured urine, pain abdomen since 4 days and yellowish discolouration of eyes 3 days. He is K/c/o Myasthenia gravis ,HTN , Type 2 diabetes, Alcoholic liver disease. Patient diagnosed as Hydatid cyst .Posted for excision .Case accepted under ASA grade 3 risk with high risk consent. Anaesthetic plan- Combined epidural and Spinal anaesthesia. Epidural catheter inserted at the level T7-T8.