Background and Goal of Study:
The objective of this study is to validate a protocol for the anesthetic management of patients with myasthenia gravis (MG) scheduled for thymectomy. MG is a neurological disease that affects the motor end-plate in which auto-antibodies against acetylcholine (Ach) receptors are produced causing muscular weakness leading to respiratory depression. Since many of the drugs frequently used in anesthesia may affect the motor end-plate, we designed a protocol for providing safe general anesthesia in patients with MG in which the risk of postoperative respiratory depression and the need for re-intubation in the intensive care unit are decreased.
We designed a protocol for providing safe anesthetic care for patients with MG that received surgical resection of the thymus as part of the treatment for MG in the last 10 years in our hospital. The medical and anesthetic records of 27 patients that received anesthetic management according to the designed protocol were extensively reviewed.
Twenty-seven patients were taken to the OR for surgical resection of the thymus as part of the treatment for MG. All of them received endotracheal extubation at the end of the surgery without complications according to the designed protocol and the Leventhal Score. There was no need for re-intubation in any of the patients during the postoperative period due to respiratory depression caused by muscle weakness.
Conclusions and Discussion:
Patients with MG are a major challenge for the anesthesiologist due to the pathophysiology of the disease, the limitation for medications used and the risk of postoperative respiratory depression. We designed a protocol for the safe anesthetic care of these patients that decreases the risk for re-intubation during the in-hospital stay time. There were no complications reported related to the anesthetic management.
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© 2012 European Society of Anaesthesiology