Abstract
Background
Myasthenia gravis is a challenging clinical condition due to its neuromuscular involvement. We sought to compare two non-muscle relaxant anesthetic techniques in patients undergoing trans-sternal thymectomy, evaluating the intra and postoperative conditions including extubation in the operating room.
Methods
Eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized into two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (2mg. Kg−1) and intubation performed after topical anesthesia of the airway with lignocaine. Anesthesia was maintained in the propofol group (4 patients) with continuous propofol infusion (3–10 mg. Kg−1., hr−1) with oxygen and nitrous oxide and in the sevoflurane group (4 patients), with sevoflurane (end tidal 1–1.5%) in oxygen and nitrous oxide. Fentanyl was used for analgesia in both the groups. Intubating conditions, haemodynamic changes, neuromuscular transmission along with postoperative intensive care unit stay were evaluated. Data were evaluated using ANOVA, Chi-square test and Student'st test.
Results
Intubating conditions were good in all patients. There were no significant haemodynamic changes. All patients were extubated in the operating room and none had to be re-intubated for postoperative respiratory depression. Neuromuscular transmission showed minimal changes and at the end of the procedure the recovery was complete in all the patients. There were no other significant differences between the two groups studied.
Conclusion
These two anesthetic techniques allow early extubation of myasthenic patients in the operating room.
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Sanjay, O.P., Prashanth, P., Karpagam, P. et al. Propofol or sevoflurane anesthesia without muscle relaxants for thymectomy in myasthenia gravis. Indian J Thorac Cardiovasc Surg 20, 83–87 (2004). https://doi.org/10.1007/s12055-004-0047-2
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DOI: https://doi.org/10.1007/s12055-004-0047-2