Criteria for Postoperative Mechanical Ventilation After Thymectomy in Patients With Myasthenia Gravis: A Retrospective Analysis

Prediction of Postoperative Mechanical Ventilation After Thymectomy in Patients With Myasthenia Gravis: A Myth or Reality

“…When combining together previous findings and this new report 3 we must consider multiple factors besides preoperative variables that affect outcomes including intraoperative factors. For instance the Chigurupati study 3 reported the use of sevoflurane, opioids, atracurium, and in one-third of the cases thoracic epidural analgesia as part of the management.…”

“…In this volume, Chigurupati et al 3 had reviewed in a retrospective analysis the preoperative variables associated with postoperative mechanical ventilation after transsternal thymectomy in order to predict the patients that would require prolong mechanical ventilation after surgery (ie, 4 300 min). Their study compiles 10 years of experience involving 77 patients with myasthenia gravis, divided into two groups.…”

“…Is there any indication to maintain all myasthenia gravis patients intubated and mechanically ventilated after surgery in order to determine what preoperative variables can be a risk factor as shown by Chigurupati? 3 In a prospective study 5 comparing two non-muscle relaxant anesthesia techniques (propofol plus N 2 O, n ¼ 36 patients; versus sevoflurane plus N 2 O, n ¼ 32 patients) in myasthenia gravis patients undergoing transsternal thymectomy, it showed that all patients were extubated in the operating room at the conclusion of surgery and none of the patients required reintubation. What is different when comparing to the present study?…”

“…What is different when comparing to the present study? 3 Their study used non-depolarizing muscle relaxant (atracurium). Unfortunately their report has limited information related to the dose or frequency of atracurium used intraoperatively or mention of any attempt to use a reversal agent for the muscle relaxant.…”

“…Based upon the response of train-on-four the authors were able to titrate the dose of atracurium needed and all patients were extubated within 30 minutes after surgery. The Chigurupati 3 was performed using train-of-four without specifics. Use of the train-of-four monitor for titration of the dose of non-depolarization relaxants is commonly used in patients with myasthenia gravis undergoing thymectomy.…”