Criteria for Postoperative Mechanical Ventilation After Thymectomy in Patients With Myasthenia Gravis: A Retrospective Analysis
| Autor: | Shrinivas Gadhinglajkar, Manjusha N. Pillai, Rupa Sreedhar, Madathipat Unnikrishnan, Keerthi Chigurupati, Muraleedharan Nair |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Thymoma medicine.medical_treatment 03 medical and health sciences Postoperative Complications 0302 clinical medicine Myasthenia Gravis medicine Humans In patient Retrospective Studies Mechanical ventilation business.industry Medical record Retrospective cohort study Perioperative Middle Aged Thymectomy medicine.disease Respiration Artificial Myasthenia gravis Surgery Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Anesthesia Female Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 32:325-330 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2017.06.045 |
| Popis: | To determine the criteria for postoperative mechanical ventilation after thymectomy in patients with Myasthenia Gravis.Retrospective study.Teritiary care centre.77 Myasthenia gravis patients operated for thymectomy were studied.After obtaining clearance from Institutional ethics committee, medical records of 77 patients with MG, who were operated for thymectomy between January 2005 and December 2015 were reviewed in a retrospective manner. Perioperative variables collected from the patient records were demographic data, duration of the disease, Osserman and Genkin classification, Anti-acetylcholine antibody (AChR) positivity, preoperative daily dose of drug, history of preoperative myasthenic crisis, preoperative vital capacity, technique of anesthesia, drugs used for anesthesia, perioperative complications, and duration of postoperative mechanical ventilation. The patients were divided into two groups, group I and group II consisting of those who required postoperative ventilation for300 minutes and300 minutes, respectively. The determinants of prolonged postoperative ventilation were studied.The requirement of mechanical ventilation was higher in patients with higher Osserman's grade of myasthenia gravis. Duration of the disease had no effect on the duration of mechanical ventilation in myasthenic patients post thymectomy (p = 0.89). The patients with a preoperative history of myasthenic crisis had a requirement for prolonged mechanical ventilation (p=0.03). Patients with preoperative vital capacity2.9 litres and preoperative CT scan showing thymoma had a requirement for prolonged mechanical ventilation with p values0.001 and 0.035, respectively. Patients who showed positivity for anti-acetylcholine antibodies had a prolonged mechanical ventilation (p=0.026). Preoperative dose of pyridostigmine and the choice of continuation or discontinuation of antcholinesterases on the day of surgery had no influence on the duration of mechanical ventilation (p value of 0.19 and 0.36 respectively). Epidural analgesia intra and postoperatively significantly reduced the requirement of mechanical ventilation (p=0.006).The predictors of postoperative ventilation in myasthenic patients undergoing thymectomy as per our study are: 1. Grade of myasthenia; 2. History of preoperative myasthenic crisis; 3. Anti-acetylcholine antibodies positivity; 4. Presence of thymoma; and 5. a vital capacity2.9 litres. Use of thoracic epidural as a part of combined anesthetic technique helps to reduce the need of mechanical ventilation in these patients. |
| Databáze: | OpenAIRE |
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