Thymectomy and mediastinal surgery entails a number of potentially severe perioperative concerns and complications. While thymectomies are a less common procedure, the disease progression necessitating such an intervention further complicates anesthetic management. The surgical approach varies widely depending on the age, size, and location of the lesion involved and the anesthetic plan therefore diversifies to accommodate. This chapter discusses the clinical presentation and potential complications that arise, in order to safely implement a perioperative plan. Due consideration is applied to unique concerns in and out of the operative setting to optimize patients for surgery and mitigate potential severe adverse outcomes. Table 17.1 provides a summary of the considerations for providing anesthesia to patients undergoing thymectomy.
NIH/US National Library of Medicine (MeSH, Medical Subject Headings) Thymectomy [E04.928.770] Sternotomy [E04.928.710] Mediastinoscopy [E04.928.490] Pulmonary Surgical Procedures [E04.928.600] Thoracic Surgical Procedures [E.04.928] Myasthenia Gravis [C10.114.656] Autoimmune Diseases of the Nervous System [C10.114] Cardiopulmonary Bypass [E04.292.413] Thymoma [C04.588.894.949.500] Thymus Neoplasms [C04.588.894.949] Anesthesia, General [E03.155.197]
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Lucchi M, Van Schil P, Schmid R, Rea F, Melfi F, Athanassiadi K, Zielinski M, Treasure T. Thymectomy for thymoma and myasthenia gravis. A survey of current surgical practice in thymic disease amongst EACTS members. Interact Cardiovasc Thorac Surg. 2012;14(6):765–70.CrossRefPubMedPubMedCentralGoogle Scholar
Rosa GR, Takizawa N, Schimidt D, Sugita M. Surgical treatment of superior vena cava syndrome caused by invasive thymoma. Rev Bras Cir Cardiovasc. 2010;25(2):257–60.CrossRefPubMedPubMedCentralGoogle Scholar
Azizkhan RG, Dudgeon DL, Buck JR, et al. Life-threatening airway obstruction as a complication to the management of mediastinal masses in children. J Pediatr Surg. 1985;20:816–22.CrossRefPubMedGoogle Scholar
Pravash UBS, Abel MD, Hubmayr RD. Mediastinal masses. A case report and review of the literature. Anaesthesia. 1984;39:899–903.CrossRefGoogle Scholar
Giannopoulou A, Gkiozos I, Harrington KJ, Syrigos KN. Thymoma and radiation therapy: a systematic review of medical treatment. Expert Rev Anticancer Ther. 2013;13(6):759–66.CrossRefPubMedPubMedCentralGoogle Scholar
Shrager JB, Deeb ME, Mick R, et al. Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg. 2002;74:320–6.CrossRefPubMedPubMedCentralGoogle Scholar
Tsunezuka Y, Oda M, Matsumoto I, Tamura M, Watanabe G. Extended thymectomy in patients with myasthenia gravis with high thoracic epidural anesthesia alone. World J Surg. 2004;28(10):962–5.CrossRefPubMedPubMedCentralGoogle Scholar
Baraka A, Baroody M, Yazbeck V. Repeated doses of suxamethonium in the myasthenic patient. Anaesthesia. 1993;28:782–4.CrossRefGoogle Scholar
Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55(1):7–15.CrossRefPubMedGoogle Scholar
Lin M, Chang Y, Huang P, Lee Y. Thymectomy for non-thymomatous myasthenia gravis: a comparison of surgical methods and analysis of prognostic factors. Eur J Cardiothorac Surg. 2010;37:7–12.CrossRefPubMedGoogle Scholar
Kim HK, Park MS, Choi YS, et al. Neurologic outcomes of thymectomy in myasthenia gravis: comparative analysis of the effect of thymoma. J Thorac Cardiovasc Surg. 2007;134(3):601–7.CrossRefPubMedGoogle Scholar
Ng JK, Ng CS, Underwood MJ, Lau KK. Does repeat thymectomy improve symptoms in patients with refractory myasthenia gravis. Interact Cardiovasc Thorac Surg. 2014;18(3):376–80.CrossRefPubMedGoogle Scholar