Document Detail

Extended thymectomy in patients with myasthenia gravis with high thoracic epidural anesthesia alone.
MedLine Citation:
PMID:  15573247     Owner:  NLM     Status:  MEDLINE    
Successful extended thymectomy was performed in three patients with myasthenia gravis under only high thoracic epidural anesthesia with voluntary breathing. It was not necessary to intubate a tracheal tube during operation for any of the patients. Neither muscle relaxants nor volatile anesthetic agents were required. The mean operating time was 2.0 +/- 0.5 hours. The drainage tubes were removed the day after operation in all patients. In two patients the arterial oxygen saturation (SaO2) and the arterial partial pressure of carbon dioxide (PaCO2) and oxygen (PaO2) were stable; in the third patient the SaO2 was temporarily decreased to 92 mmHg when bilateral mediastinal pleura were opened. The right pleural defect was then covered with a large wet towel, which was pressed on the defect, and thoracic drainage was performed. The left pleural defect was repaired with 3-0 Vicryl after suctioning the air in the pleural space, after which the SaO2 recovered. All patients were able to drink water and walk within 1 hour after the operation. This procedure is advantageous in that the use of muscle relaxants and volatile anesthetic agents prevented the laryngeal injury that results from translaryngeal intubation; in turn we avoided causing postoperative respiratory insufficiency. This may be suitable for the operation of some patients with MG, but further studies are required to define the indication.
Yoshio Tsunezuka; Makoto Oda; Isao Matsumoto; Masaya Tamura; Go Watanabe
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Publication Detail:
Type:  Journal Article     Date:  2004-09-29
Journal Detail:
Title:  World journal of surgery     Volume:  28     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-12-01     Completed Date:  2005-02-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  962-5: discussion 965-6     Citation Subset:  IM    
Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Takaramachi 13-1, Kanazawa 920-8641, Japan.
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MeSH Terms
Anesthesia, Epidural / methods*
Anesthesia, General
Intubation, Intratracheal
Middle Aged
Myasthenia Gravis / surgery*
Postoperative Complications / prevention & control
Thymectomy / methods*

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