Sevoflurane as a sole anaesthetic for thymectomy in myasthenia gravis

Abstract

Myasthenia gravis is a challenging situation for anaesthesiologists due to its neuromuscular involvement. The main concerns are respiratory muscle weakness and side effects due to a heavy dose of anticholinesterases. This limits the use of sedatives, hypnotics and muscle relaxants. Inhalational anaesthetics are best suited. We describe our experience with sevoflurane as a sole anaesthetic in a child having juvenile-type myasthenia gravis with thymoma, who underwent thymectomy by midsternal incision. Very smooth and short duration of induction (35 s) and easy intubation within 60 s without use of muscle relaxant were the remarkable features. Sevoflurane in oxygen and nitrous oxide (MAC=0.5-0.7) was used for maintenance of anaesthesia. Recovery was smooth and fast with no residual respiratory insufficiency. Hence we found sevoflurane to be a highly suitable agent for thymectomy in mysthenia gravis.

Anaesthesiology and intensive care The use of sugammadex for the reversal of neuromuscular blockade after thymectomy with videothoracoscopy in myasthenia gravis patients – a preliminary report

“…The standards developed on the basis of in-house studies are in accordance with the suggestions of many authors, whose research indicates that myasthenia patients are more sensitive to the "relaxing" effect of inhaled agents [15,16].…”

Laryngeal Mask Airway insertion with total intravenous anesthesia for transsternal thymectomy in patients with myasthenia gravis: report of 5 cases

“…However, consensus regarding the superiority of a specific technique has not been established [1,[6][7][8][9]. Itoh and Shibata [12] reported that the effect of propofol on the neuromuscular junction was less than the effect of sevoflurane in the same patient who underwent two separate anesthetic treatments.…”

“…Anesthetic techniques, including intubation without a muscle relaxant, TIVA, or sevoflurane administration alone, have been used in transsternal thymectomy [1,[6][7][8][9]. Most patients with MG require thymectomy for the control and treatment of their disease.…”

Awake anaesthesia for major thoracic surgical procedures: an observational study

“…Avoiding muscle relaxants in patients with myasthenia gravis can potentially lower the risk of postoperative muscle weakness and respiratory insufficiency thus leading to faster patient's recovery [9][10][11][12]. Other possible advantages of thoracic epidural anaesthesia include better patients' satisfaction, reduced hospital length of stay, and improved resource utilization.…”