Postoperative management after thymectomy.

نویسندگان

  • A B Loach
  • A C Young
  • J M Spalding
  • A C Smith
چکیده

This paper reports a retrospective study of the preoperative and postoperative management of 28 patients who underwent thymectomy between 1956 and 1973. Patients who received postoperative artificial ventilation were compared with the group who did not with respect to sex, age, severity of disease, preoperative vital capacity, and thymic histology. Evidence is presented that postoperative artificial ventilation is required when the preoperative vital capacity with the patient on optimum anticholinesterase treatment is less than 2 litres. Additional features associated with a probable need for artificial ventilation were the presence of a thymoma, bulbar symptoms, especially dysphagia, and age over 50 years. These should be taken into account in any patient whose vital capacity is close to the critical level of 2 litres. When postoperative ventilation was required it was usually necessary for 12 days or more, and tracheostomy should therefore be done at or before thymectomy. Most patients in this series received the same dose of anticholinesterases after operation as before it and no evidence was found of a sudden decrease in requirements for anticholinesterase therapy. Two patients did not, and in them a myasthenic crisis was precipitated. We propose that the preoperative drug regimen can be continued in the immediate postthymectomy period, allowing selection of patients for tracheostomy and artificial ventilation primarily on the basis of the preoperative vital capacity.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Myasthenia gravis appearing after thymectomy for thymoma.

OBJECTIVE A few thymoma patients without myasthenia gravis (MG) have been observed to develop MG after total removal of the thymoma (postoperative MG). However, the cause of this is not yet known because of the rarity of postoperative MG patients. This study evaluated the clinical characteristics of the 8 postoperative MG patients. METHODS We compiled 1089 thymoma patients treated between 199...

متن کامل

Influence of body mass index on postoperative complications after thymectomy in myasthenia gravis patients

OBJECTIVES It is not clear whether being overweight or obese influences postoperative complications in myasthenia gravis (MG) patients. We retrospectively investigated an association between body mass index (BMI) and postoperative complications in MG. MATERIALS AND METHODS Fifty-nine MG patients who had undergone transsternal thymectomy were classified as low or high BMI based on the criteria...

متن کامل

Anesthesia for trans-sternal thymectomy: modified non-muscle relaxant technique.

Anesthesia for thymectomy in myasthenia gravis is challenging. Early surgical management is now considered to be an important therapeutic intervention for most of the patients of myasthenia gravis. The anesthetic experience of that technique is quite large. It involves either muscle relaxant or non-muscle relaxant techniques. However, the literature is deficient of standard anesthetic technique...

متن کامل

The Immediate Postoperative Care of the Myasthenic Patient following Thymectomy.

The problems which arise in dealing with the myasthenic patient in the immediate postoperative period following thymectomy are discussed. The indications for and advantages of spontaneous ventilation, elective tracheostomy and intermittent positive pressure ventilation are considered and the benefits of managing all such cases in an intensive care unit are stressed. It is considered that only i...

متن کامل

Preoperative risk factors for prolonged postoperative ventilation following thymectomy in myasthenia gravis.

UNLABELLED Adequate preoperative evaluation and preparation for surgery are required to prevent prolonged mechanical ventilation after thymectomy, and facilitate the recovery of patients with myasthenia gravis (MG). The objective of this study was to identify the preoperative risk factors for extubation failure after thymectomy in patients with MG. METHODS A retrospective study was conducted ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • British medical journal

دوره 1 5953  شماره 

صفحات  -

تاریخ انتشار 1975