The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video‐assisted thoracoscopic‐extended thymectomy

Gritti, Paolo; Carrara, B.; Khotcholava, M.; Bortolotti, G; Giardini, D.; Lanterna, Luigi Andrea; Benigni, Alberto; Sonzogni, Valter

doi:10.1111/j.1399-6576.2008.01853.x

Cited by 27 publications

(13 citation statements)

References 33 publications

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“…2008), which makes it appealing for use in the myasthenic animal. In myasthenic humans, the use of a balanced technique with remifentanil and an inhalant or propofol, was successful (Mekis & Kamenik 2005; Gritti et al. 2009).…”

Section: Discussionmentioning

confidence: 99%

Thymoma removal in a cat with acquired myasthenia gravis: a case report and literature review of anesthetic techniques

Shilo

Pypendop

Barter

et al. 2011

Veterinary Anaesthesia and Analgesia

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Section: Discussionmentioning

confidence: 99%

Thymoma removal in a cat with acquired myasthenia gravis: a case report and literature review of anesthetic techniques

Shilo

Pypendop

Barter

et al. 2011

Veterinary Anaesthesia and Analgesia

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“…A commercial infusion pump (Orchestra®; Fresenius Vial, Brezins, France) was used for target-controlled infusion of propofol and remifentanil according to the patients’ demographic data (sex, age, height and weight). The techniques for anesthesia maintenance in our study were based on those described in previous studies and textbooks [17–20]. Infusion of propofol was monitored with the Marsh pharmacokinetic model and remifentanil with the Minto model.…”

Section: Methodsmentioning

confidence: 99%

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

et al. 2017

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BackgroundOne-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However, the effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human study. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil anesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery.MethodsAdult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative oxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion in both groups. Mechanical ventilation was performed with tidal volume of 8 ml/kg and FIO2 0.5 during two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation, both with positive end-expiratory pressure of 5 cmH2O. Arterial blood gas analysis was performed preoperatively, during two-lung ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The primary endpoint was PaO2 at 30 min after initiating one-lung ventilation. Statistical analyses included the independent t-test for the primary endpoint and a mixed model with a post-hoc analysis to evaluate the serial changes in values.ResultsPatients were recruited between July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52 in desflurane group and n = 51 in propofol group). The primary endpoint, PaO2 at 30 min of one-lung ventilation was lower in the desflurane group than the propofol group (170 ± 72 vs. 202 ± 82 mmHg; p = 0.039). Serial changes in PaO2 during one-lung ventilation showed lower levels during desflurane anesthesia compared with propofol anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16–75 mmHg; p = 0.003).ConclusionsIn conclusion, desflurane-remifentanil anesthesia resulted in decreased arterial oxygenation compared with that of propofol-remifentanil anesthesia during one-lung ventilation for thoracoscopic surgery in patients with lung cancer.Trial registrationClinicalTrials.gov identifier: NCT02191371, registered on July 7, 2014

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

et al. 2011

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Background:Juvenile myasthenia gravis (JMG) is the rare form of myasthenia gravis presenting in childhood and adolescence. When medical management fails, thymectomy is offered for these patients. Complete resection of the thymus is best achieved through transsternal thymectomy. Anesthetic management of patients with JMG is challenging, particularly in regards to the goals of postoperative pain control, respiratory function, and extubation.Methods:We retrospectively reviewed the medical records of 13 patients, ranging in age from 6 to 22 years, who underwent transsternal thymectomy for JMG. Information on patient demographics, characteristics of their disease and treatment, anesthetic management, and postoperative course were collected.Results:All patients had undergone multiple treatment modalities and presented for surgery because of inadequate symptom control with medical management. As expected for a pediatric population, anesthesia induction was age dependent. 40% of the patients underwent an inhalation induction and 60% underwent an intravenous induction. Anesthesia was maintained with a low-dose inhalation agent in all patients, supplemented in 84% of patients with a remifentanil infusion, and in 69% of patients with an epidural infusion. Muscle relaxants were avoided in all patients. With this regimen, 92% of patients could be extubated successfully in the operating room.Conclusion:We found that avoidance of muscle relaxants and use of remifentanil with a low-dose hypnotic agent provided a stable intraoperative course, facilitated rapid emergence, and allowed early extubation in patients with JMG undergoing transsternal thymectomy. Epidural analgesia reduced the need for intra- and postoperative intravenous opioids and did not have an adverse effect on respiratory strength.

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The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video‐assisted thoracoscopic‐extended thymectomy

Cited by 27 publications

References 33 publications

Thymoma removal in a cat with acquired myasthenia gravis: a case report and literature review of anesthetic techniques

Thymoma removal in a cat with acquired myasthenia gravis: a case report and literature review of anesthetic techniques

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

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