Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients

Abstract

P Pu ur rp po os se e: : To compare two non-muscle relaxant anesthetic techniques in myasthenic patients undergoing trans-sternal thymectomy, evaluating the intra-and postoperative conditions including the early extubation in the operating room.M Me et th ho od ds s: : Sixty-eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized in two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (1-2 mg·kg -1 ) and intubation performed after topical anesthesia of the airway with lidocaine. Anesthesia was maintained in the propofol group (36 patients) with a continuous propofol infusion (3-6 mg·kg -1 ·hr -1 ) and nitrous oxide and, in the sevoflurane group (32 patients), with sevoflurane (end-tidal 1-1.5%) in O 2 :N 2 O. Intubating conditions, hemodynamic changes, neuromuscular transmission, postoperative intensive care unit and hospital length of stay and complications were evaluated. Data were analyzed with repeated measure two-way analysis of variance (ANOVA), Chi square test and Student's t test.R Re es su ul lt ts s: : Intubating conditions were good in all patients. There were no hemodynamic 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, more important in the sevoflurane group, and at the end of the procedure the recovery was complete in all patients. We did not observe any other significant differences between the two groups studied.C Co on nc cl lu us si io on n: : Our data show that these two anesthetic techniques allow the early extubation of myasthenic patients in the operating room. Objectif

Sevoflurane and thoracic epidural anesthesia for trans-sternal thymectomy in a child with juvenile myasthenia gravis

“…[8] In a series of 68 adult patients for trans-sternal thymectomy, propofol, or sevoflurane anesthesia could avoid muscle relaxant and all the patients could be extubated in the operating room. [9] TIVA with propofol and remifentanyl infusion has been used for thymectomy which decreased the need for muscle relaxants. [13] Opioids at therapeutic concentration have no effect on neuromuscular transmission but central respiratory depression is a concern.…”

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

“…Total intravenous anesthesia avoids the muscle relaxing effect of inhalational agents[8] and may facilitate early extubation,[9] but does not have clinical advantages. [1011] Muscle relaxants are not generally contraindicated but should be used with caution. Due to the decreased receptor density, patients with JMG are resistant to succinylcholine.…”

Anaesthetic Considerations in Paediatric Myasthenia Gravis

“…In the paediatric setting, this is already well described and used frequently. Tracheal intubation with volatiles alone or following an iv induction with propofol and a short-acting opioid are well described in myasthenic children [39–42]. The use of propofol and remifentanil in the form of target-controlled infusion (TCI) is well described in adult myasthenics [43, 44].…”