Anesthesia for thymectomy in patients with myasthenia gravis

Abstract

INTRODUCTION: Anesthetic approach to patients with myasthenia gravis requires preoperative treatment with anticholinesterase drugs, corticosteroids, plasmapheresis and mechanical ventilation support, either before or immediately after the surgical procedure. MATERIAL AND METHODS: During the period of 10 years, 41 patients with myasthenia gravis (71.42% female and 28.57% male, aged between 9 and 69 years) underwent surgical procedures. All the patients were preoperatively treated with anticholinesterase drugs and corticosteroids and were in remission. Considering the fact that barbiturates and succinylcholine should be avoided during induction of anesthesia, halothane was used. The induction into the surgical stage of anesthesia was pronged. RESULTS: Intubation, as well as the surgical procedure, were successfully completed in all patients. All, except three patients, started breathing spontaneously. Two patients required respiratory support during the immediate postoperative period and one patient died. After the surgical procedure one patient had manifested gastrointestinal bleeding and three patients had pneumothorax (one iatrogenic and two during mechanical ventilation). Mechanical ventilation in postoperative period indicates inadequate respiratory function in patients with myasthenia gravis, whereas thymectomy is a therapy of choice. Volatile inhalation anesthetic with pre and postoperative anticholinesterase drugs and corticosteroids resulted in complete remission.