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Anesthesiological Problems in Thymus Gland Surgery

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Thymus Gland Pathology

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Abstract

In Italy, about 15,000 patients are known to suffer from myasthenia gravis; however, in other cases the condition is not diagnosed or is confused with other pathologies. In Europe, it is thought that about 6 in 100,000 inhabitants are affected, and in the USA the incidence has been estimated at 20 cases for every 100,000 inhabitants. As regards the patient’s age at onset, there are two peaks: between 20 and 40 years of age (women most affected) and 60 to 80 years (no difference between the sexes). This data would suggest that myasthenia gravis patients rarely undergo surgery; on the contrary, as thymectomy causes a significant improvement in symptoms in 40–90% of cases and complete remission of the disease in 25% of cases, surgery in patients with myasthenia gravis (especially in large centers with a Chest Surgery Unit) is not uncommon [1].

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References

  1. Kaplan JA, Slinger PD (2003) Thoracic anesthesia, 3rd edn. Elsevier Science, pp 281–294

    Google Scholar 

  2. Osserman KE, Genkins G (1971) Studies in myasthenia gravis: Review of a twenty-year experience in over 1,200 patients. J Mt Sinai Hosp 38:497–503

    CAS  Google Scholar 

  3. Hermann C, Lindstrom JM, Kessey JC et al (1985) Myasthenia gravis-Current concepts. West J Med 142:797

    Google Scholar 

  4. Romi F, Gilhus NE, Aarli JA (2005) Myasthenia gravis: Clinical, immunological, and therapeutic advance. Acta Neurol Scand 111:134–141

    Article  PubMed  CAS  Google Scholar 

  5. Millard CB, Bromfield CA (1995) Anticholinesterases: Medical applications of neurochemical principles. J Neurochem 64:1909–1918

    Article  PubMed  CAS  Google Scholar 

  6. Gaidos P, Chevret S, Toyka K (2002) Plasma exchange for myasthenia gravis. Cochrane Database Syst Rev 4:CD002275

    Google Scholar 

  7. Gaidos P, Chevret S, Toyka K (2003) Intravenous immunoglobulin for myasthenia gravis. Cochrane Database Syst Rev 2:CD002277

    Google Scholar 

  8. Philip E, Levarenne J, Dordain G (1985) Myasthénie et médicaments: Évaluation critique des contre-indications. Press Med 14, 515–516

    Google Scholar 

  9. Martin C, Auffray JP (1990) Il periodo perioperatorio del miastenico. Anestesia Rianimazione, 36657 C10. EMC, Roma, p 8

    Google Scholar 

  10. Viby-Mogensen J (1985) Interaction of other drugs with muscle relaxants. In: Katz RJ (ed) Muscle relaxants. Basic and critical aspects. Gune and Stratton, Orlando, pp 233–256

    Google Scholar 

  11. Swash M, Ingram DA (1992) Adverse effect of verapamil in myasthenia gravis. Muscle Nerve 15(3):396–398

    Article  PubMed  CAS  Google Scholar 

  12. Scappaticci KA, Ham JA, Sohn J et al (1982) Effects of furosemide on the neuromuscolar junction. Anesthesiology 57:381–388

    Article  PubMed  CAS  Google Scholar 

  13. Rall TW, Schleifer LS (1985) Drugs effective in the therapy of the epilepsies. In: Goodman LS, Gilman A (eds) The pharmacological basis of therapeutics. MacMillan Publishing Co., New York, pp 446–472

    Google Scholar 

  14. Booker HE, Chun RW, Sanguini M (1970) Myasthenia gravis syndrome associated with trimethadione. JAMA 212(13):2262–2263

    Article  PubMed  CAS  Google Scholar 

  15. Orts A, Marti JL, Baltar I et al (1979) Inhibition neuro-musculaire de nouveaux antibiotiques aminoglucosids. Ann Anesthesiol Fr 20:25–30

    PubMed  CAS  Google Scholar 

  16. Gunduz A, Turedi S, Kalkan A et al (2006) Levofloxacin induced myasthenia crisis. Emerg Med J 23:662

    Article  PubMed  CAS  Google Scholar 

  17. Sieb JP (1998) Fluoroquinolone antibiotics block neuromuscolar transmission. Neurology 50:804–807

    PubMed  CAS  Google Scholar 

  18. Abel M, Eisenkraft JB (2002) Anesthetic implications in myasthenia gravis. Mt Sinai J Med 69:31–37

    PubMed  Google Scholar 

  19. Eisenkraft JB, Book VJ, Mann SM et al (1988) Resistance to succinylcholine in myasthenia gravis: A doseresponse study. Anesthesiology 69:760–763

    Article  PubMed  CAS  Google Scholar 

  20. Baraka A (1992) Suxamethonium block in the myasthenic patient. Correlation with plasma cholinesterase. Anesthesia 47:217–219

    Article  CAS  Google Scholar 

  21. Seigne RD, Scott RP (1994) Mivacurium chloride and myasthenia gravis. Br J Anaesth 72:468–469

    Article  PubMed  CAS  Google Scholar 

  22. Blitt CD, Wright WA, Peat J (1975) Pancuronium and the patient with myasthenia gravis. Anesthesiology 42:624–626

    Article  PubMed  CAS  Google Scholar 

  23. Itoh H, Shibata K, Nitta S (2001) Difference in sensitivity to vecuronium between patients with ocular and generalized myasthenia gravis. Br J Anaesth 87(6):885–889

    Article  PubMed  CAS  Google Scholar 

  24. Itoh H, Shibata K, Nitta S (2002) Sensitivity to vecuronium in seropositive and seronegative patients with myasthenia gravis. Anesth Analg 95(1):109–113

    Article  PubMed  CAS  Google Scholar 

  25. Mann R, Blobner M, Jelen-Esselbom S et al (2000) Preanesthetic train-of-four fade predicts the atracurium requirement of myasthenia gravis patients. Anesthesiology 93(2):346–350

    Article  PubMed  CAS  Google Scholar 

  26. Smith CE, Donati F, Bevin DR (1989) Cumulative dose-response curves for atracurium in patients with myasthenia gravis. Can J Anaesth 36:402–406

    Article  PubMed  CAS  Google Scholar 

  27. Baraka AS, Siddik S, Kawkabani NI (1999) Cisatracurium in a myasthenic patient undergoing thymectomy. Can J Anesth 46(8):779–782

    Article  PubMed  CAS  Google Scholar 

  28. Baraka AS, Taha SK, Kawkabani NI (2000) Neuromuscular interaction of sevoflurane-cisatracurium in a myasthenic patient. Can J Anesth 47(6):562–565

    Article  PubMed  CAS  Google Scholar 

  29. Seigne RD, Scott RP (1994) Mivacurium chloride and myasthenia gravis. Br J Anaesth 72:468–469

    Article  PubMed  CAS  Google Scholar 

  30. Cordero Escobar I, Benitez Tang SM, Parisi Lopez N (2002) Use of mivacurium chloride during transsternal thymectomy in myasthenic patient. Rev Esp Anestesiol Reanim 49(7):360–364

    PubMed  CAS  Google Scholar 

  31. Gissen AJ, Karris JH, Nastuk VL (1966) Effect of halothane on neuromuscular transmission. JAMA 197:770–774

    Article  PubMed  CAS  Google Scholar 

  32. Nilsson E, Muller K (1990) Neuromuscolar effects of isoflurane in patients with myasthenia gravis. Acta Anaesth Scand 34:126–131

    Article  PubMed  CAS  Google Scholar 

  33. Kadosaki M, Enzan K, Horiguchi T et al (1993) Severity of myasthenia gravis is related to the degree of neuromuscular blocking effect by isoflurane. Masui 42:906–909

    PubMed  CAS  Google Scholar 

  34. Eisenkraft JB, Papatestas AE, Sivak M (1984) Neuromuscolar effects of halogenated agents in patients with myasthenia gravis (abstract). Anesthesiology 61:A307

    Article  Google Scholar 

  35. Russel SH, Hood JR, Campkin M (1993) Neuromuscolar effects of enflurane in myasthenia gravis (abstract) Br J Anaesth 71:766P

    Google Scholar 

  36. Nitahara K, Sugi Y, Higa K et al (2007) Neuromuscolar effects of sevoflurane in myasthenia gravis patients. Br J Anaesth 98(3):337–341

    Article  PubMed  CAS  Google Scholar 

  37. Kiran U, Choudhury M, Saxena L et al (2000) Sevoflurane as a sole anaesthetic agent for thymectomy in myasthenia gravis. Acta Anaesth Scand 44:351–353

    Article  PubMed  CAS  Google Scholar 

  38. Baraka A, Siddik S, el Rassi T et al (2000) Sevoflurane anesthesia in a myasthenic patient undergoing transternal thymectomy. Middle East J Anesthesiol 15(6):603–609

    PubMed  CAS  Google Scholar 

  39. Caldwell JE, Laster MJ, Magorian T et al (1991) The neuromuscolar effects of desflurane alone and combined with pancuronium or succinylcholine in humans. Anesthesiology 74:412–418

    Article  PubMed  CAS  Google Scholar 

  40. Hubler M, Litz RJ, Albrecht DM (2000) Combination of balanced and regional anaesthesia for minimally invasive surgery in a patient with myasthenia gravis. Eur J Anaesthesiol 17(5):325–328

    PubMed  CAS  Google Scholar 

  41. Ng JM (2006) Total intravenous anesthesia with propofol and remifentanil for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Anesth Analg 103(1):256–257

    Article  PubMed  Google Scholar 

  42. Fodale V, Praticò C, Piana F et al (2003) Propofol and remifentanil without muscle relaxants in a patient with myasthenia gravis for emergency surgery. Can J Anaesth 50(10):1083–1084

    Article  PubMed  Google Scholar 

  43. Della Rocca G, Coccia C, Diana L et al (2003) Propofol or sevoflurane anesthesia without muscle relaxant allow the early extubation of myasthenic patient. Can J Anaesth 50(6):547–552

    PubMed  Google Scholar 

  44. De Grood PM, Mitusukuri S, Van Egmond J et al (1987) Comparison of etomidate and propofol for anaesthesia in microlaryngeal surgery. Anaesthesia 42:366–372

    Article  PubMed  Google Scholar 

  45. Bagshaw O (2007) A combination of total intravenous anesthesia and thoracic epidural for thymectomy in juvenile myasthenia gravis. Paediatr Anaesth 17(4):370–374

    Article  PubMed  Google Scholar 

  46. El-Dawlatly AA, Al Kattan K, Hajjar W et al (2005) Anesthetic implications for video assisted thoracoscopic thymectomy in myasthenia gravis. Middle East J Anesthesiol 18(2):339–345

    PubMed  Google Scholar 

  47. Matsuo S, Rao DBS, Chaudry I et al (1978) Interaction of muscle relaxants and local anesthetics at the neuromuscolar junction. Anesth and Analg 57:580–587

    Article  CAS  Google Scholar 

  48. Lopez-Berlanga JL, Garutti I, Martinez-Campos E et al (2006) Bilateral paravertebral block anesthesia for thymectomy by video-assisted thoracoscopy in patients with myasthenia gravis. Rev Esp Anestesiol Reanim 53(9):571–574

    PubMed  CAS  Google Scholar 

  49. Mulder DG, Hermann C, Buckberg GB (1974) Effect of thymectomy in patients with myasthenia gravis. Am J Surg 128:202–206

    PubMed  CAS  Google Scholar 

  50. Cohn HE, Solit RW, Schatz NS et al (1974) Surgical treatment in myasthenia gravis: A 27-year experience. J Thorac Cardiovasc Surg 68:876–885

    PubMed  CAS  Google Scholar 

  51. Papatestas AE, Alpert LL, Ossermann KE et al (1971) Studies in myasthenia gravis: Effects of thymectomy, results on 185 patients with nonthymomatous and thymomatous myasthenia gravis 1941-1969. Am J Med 50:465–474

    Article  PubMed  CAS  Google Scholar 

  52. Loach AB, Young AC, Spalding JMK et al (1975) Postoperative management after thymectomy. Br Med J 1:309–312

    Article  PubMed  CAS  Google Scholar 

  53. Leventhal SR, Orkin FK, Hirsh RA (1980) Prediction of the need for post-operative mechanical ventilation in myasthenia gravis. Anesthesiology 53:26–30

    Article  PubMed  CAS  Google Scholar 

  54. Gracey DR, Divertie MB, Howard FM et al (1984) Postoperative respiratory care after transsternal thymectomyin myasthenia gravis. A three-years experience in 53 patients. Chest 86:67–71

    Article  PubMed  CAS  Google Scholar 

  55. Younger DS, Braun NMT, Jaretzki A et al (1984) Myasthenia gravis: Determinants for independent ventilation after transsternal thymectomy. Neurology 34:336–340

    PubMed  CAS  Google Scholar 

  56. Pavlin EG, Holle RH, Schoene RB (1989) Recovery of airway protection compared with ventilation in humans after paralysis with curare. Anesthesiology 70:381–385

    Article  PubMed  CAS  Google Scholar 

  57. Oosterhuis HJ (1981) Observations of the natural history of myasthenia gravis and the effect of thymectomy. Ann NY Acad Sci 377:678–690

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. 2nd Anesthesia and Resuscitation Service, University of Modena and Reggio Emilia General Hospital, Modena, Italy

    Vincenzo Lucio Indrizzi, Fabio Gazzotti, Maria Antonietta Fanigliulo & Alberto Tassi

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  1. Vincenzo Lucio Indrizzi
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  2. Fabio Gazzotti
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  3. Maria Antonietta Fanigliulo
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  4. Alberto Tassi
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Editors and Affiliations

  1. Department of General Surgery and Surgical Specialities Division of Thoracic Surgery, University of Modena and Reggio Emilia General Hospital, Modena, Italy

    Corrado Lavini  & Uliano Morandi  & 

  2. Institute of Thoracic Pathology, University of Texas Anderson Cancer Center, Houston, TX, USA

    Cesar A. Moran

  3. Division of Neurology, Bolzano Hospital, Bolzano, Italy

    Rudolf Schoenhuber

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© 2008 Springer-Verlag Italia

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Indrizzi, V.L., Gazzotti, F., Fanigliulo, M.A., Tassi, A. (2008). Anesthesiological Problems in Thymus Gland Surgery. In: Lavini, C., Moran, C.A., Morandi, U., Schoenhuber, R. (eds) Thymus Gland Pathology. Springer, Milano. https://doi.org/10.1007/978-88-470-0828-1_13

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  • DOI: https://doi.org/10.1007/978-88-470-0828-1_13

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0827-4

  • Online ISBN: 978-88-470-0828-1

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