Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients.
OBJECTIVE
To compare two non-muscle relaxant anesthetic techniques in myasthenic patients undergoing trans-sternal thymectomy, evaluating the intra- and postoperative conditions including the early extubation in the operating room.


METHODS
Sixty-eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized in two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (1-2 mg x kg(-1)) and intubation performed after topical anesthesia of the airway with lidocaine. Anesthesia was maintained in the propofol group (36 patients) with a continuous propofol infusion (3-6 mg x kg(-1) x hr(-1)) and nitrous oxide and, in the sevoflurane group (32 patients), with sevoflurane (end-tidal 1-1.5%) in O2:N2O. Intubating conditions, hemodynamic changes, neuromuscular transmission, postoperative intensive care unit and hospital length of stay and complications were evaluated. Data were analyzed with repeated measure two-way analysis of variance (ANOVA), Chi square test and Student's t test.


RESULTS
Intubating conditions were good in all patients. There were no hemodynamic changes. All patients were extubated in the operating room and none had to be re-intubated for postoperative respiratory depression. Neuromuscular transmission showed minimal changes, more important in the sevoflurane group, and at the end of the procedure the recovery was complete in all patients. We did not observe any other significant differences between the two groups studied.


CONCLUSIONS
Our data show that these two anesthetic techniques allow the early extubation of myasthenic patients in the operating room.
Della Rocca
Giorgio
G
Department of Anesthesia, University of Udine, Udine, Italy. giorgio.dellarocca@dsc.uniud.it
Coccia
Cecilia
C
Diana
Laura
L
Pompei
Livia
L
Costa
Maria G
MG
Tomaselli
Eleonora
E
Di Marco
Pierangelo
P
Vilardi
Vincenzo
V
Pietropaoli
Paolo
P
D000328:Adult; D000368:Aged; D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000503:physiopathology / Q000601:surgery*; D009465:Neuromuscular Agents / Q000494:pharmacology; D009469:Neuromuscular Junction / Q000503:physiopathology; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D000077149:Sevoflurane; D009435:Synaptic Transmission / Q000187:drug effects; D013934:Thymectomy
D008738:Methyl Ethers; D009465:Neuromuscular Agents; D000077149:Sevoflurane; D015742:Propofol