Low-dose steroid after thymectomy in myasthenia gravis: is it a complete solution for postoperative respiratory insufficiency?

in the impairment of the standardization and influence rate of postoperative insufficiency. Third, preoperative physostigmine doses used and preoperative respiratory function tests are related directly to the PRI in Myasthenia Gravis patients. Reporting of this data is also needed to evaluate PRI thoroughly. Fourth, another important data that is directly related to PRI is the anesthesia technique and anesthetic agents used because of the influence they can have on the rate of postoperative respiratory insufficiency [5] . We believe two points need explanation: (a) More detailed information should be given about the anesthetic technique used, narcotics and neuromuscular blocking agents and their doses. Also the neuromuscular monitorization should be described [3] . (b) In the result section, it is stated that the use of epidural anesthesia did not differ in both groups, whereas the use of epidural anesthesia is not mentioned in the methods section [5] . More details should also be provided on epidural use, not only during the surgery but also during the surgery and in the postoperative period; epidural use only in the postoperative period for pain treatment could influence the results reported. Information Dear Sir, Postoperative respiratory insufficiency after thymectomy in Myasthenia gravis (MG) is a critical condition [1] . Currently, preventive strategies like the use of preoperative steroids after thymectomy show controversial results [2] . We have read the study done by Kataoka et al. with great interest where they have suggested that low-dose steroid treatment can prevent postoperative respiratory insufficiency (PRI) in patients with MG. However, we would like to refer to some questions and comments on the subject [3] . First, regarding the regimen of steroid in the postoperative period, two most important questions prevail: (a) Was the steroid dose lowered in the postoperative period? (b) How can the authors explain its mechanism of action? In addition, a dose of 30 mg/day prednisolone is not a low dose steroid therapy [4] . Instead of using the term ‘low-dose,’ ‘supraphysiological dose’ could be used. Furthermore, it would be more noteworthy if the cortisol levels of patients were also reported. Second, surgical technique is an important aspect that needs consideration, because it does not have the same effect on all the patients [3] . This may result in complex pathways, as steroid requirement can differ with different surgery techniques, resulting Received: December 9, 2014 Accepted: January 13, 2015 Published online: February 14, 2015