title: Looking for the best management of myasthenia gravis at the Tg.Mureş Clinic of Anesthesia and Intensive Care.
abstract: Thymectomy is one of the current management strategies for myasthenia gravis. This is observational study focused on the evolution of the surgical and anesthesiological strategies applied to the patients submitted to thymectomy initially by maximal sternotomy (in the years 1994-1998), followed by unconditioned reorientation towards thymectomy by VATS. A number of 103 patients are included, 51 thymectomy by left VATS. All the thoracoscopic thymectomy were performed in general anesthesia, the lungs were separated by left selective intubation, and the left lung was deflated during the surgical procedure. The surgical complications appeared mainly in the VATS group: one pericardial and one myocardial lesion leading to sternotomy (minimal blood loss, uneventful recovery), contralateral pleural lesion with pneumothorax. The classical approach accounted for one hemothorax. The postoperative mortality was zero in the VATS group vs. 6 out of 52 pts in the sternotomy group. The postoperative evolution confronted the anesthesiologist with the classical crises of myasthenia. Death occurred within the first three weeks following surgery. The demise in 3 cases was due to cardiac complications (preexisting cardiomyopathy complicated by ventricular arrhythmia) and respiratory failure plus sepsis (for the remaining cases that we lost). The treatment options in the ICU are discussed: plasmapheresis, immunosuppression, ventilatory support. VATS is appropriate for almost all thymectomy, but the outcome is heavily based on a team approach: neurologist, surgeon and anesthetist.
authors.affiliation: University of Medicine and Pharmacy, Tg.Mures, Clinic of Anesthesia and Intensive Care, Romania. sarumo@xnet.ro
authors.forename: Sanda-Maria
authors.initials: SM
authors.lastname: Copotoiu
authors.forename: C
authors.initials: C
authors.lastname: Copotoiu
authors.forename: V
authors.initials: V
authors.lastname: Bud
authors.forename: C
authors.initials: C
authors.lastname: Molnar
authors.forename: L
authors.initials: L
authors.lastname: Azamfirei
authors.forename: Ioana
authors.initials: I
authors.lastname: Ghitescu
authors.forename: M
authors.initials: M
authors.lastname: Măruşteri
authors.forename: Maria
authors.initials: M
authors.lastname: Dogaru
authors.forename: Klara
authors.initials: K
authors.lastname: Brânzaniuc
mesh_terms: D006801:Humans; D007362:Intensive Care Units; D009157:Myasthenia Gravis / Q000401:mortality / Q000601:surgery*; D010348:Patient Care Team; D011446:Prospective Studies; D012383:Romania; D013249:Sternum / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome