The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video-assisted thoracoscopic-extended thymectomy.
BACKGROUND
Although several studies of the use of desflurane in anesthesia have revealed many desirable qualities, there are no data on the use and effects especially on the neuromuscular function of desflurane on myasthenia gravis (MG) patients. The purpose of this study was to evaluate the use of either desflurane or propofol, both combined with remifentanil, in patients with MG undergoing a video-assisted thoracoscopic-extended thymectomy (VATET).


METHODS
Thirty-six MG patients who underwent VATET were enrolled. Nineteen patients were anesthetized with remifentanil and propofol infused with a target-controlled infusion plasma model, and 17 patients with desflurane and remifentanil. No muscle relaxant was used. The intubating conditions, hemodynamic and respiratory changes, neuromuscular transmission and post-operative complications were evaluated.


RESULTS
Neuromuscular transmission was significantly decreased in the desflurane group (6.7%, from 3% to 9% during anesthesia P=or<0.05). The intubating conditions were good in all 36 patients and 35 patients were successfully extubated in the operating room. The time-to-awakening, post-operatory pH and base excess were significantly different in the two groups, with a decreasing mean arterial pressure in the group administered with desflurane. No patients required reintubation due to myasthenic or cholinergic crisis, or respiratory failure. No other significant differences between the two groups studied were observed.


CONCLUSIONS
Our experience indicates that anesthesia with desflurane plus remifentanil in patients with MG could determine a reversible muscle relaxation effect, but with no clinical implication, allowing a faster recovery with no difference in extubation time and post-operative complications in the two groups.
Gritti
P
P
Department of Neuroscience-Anesthesia and Intensive Care IV, Ospedali Riuniti di Bergamo, Largo Barozzi no. 1, Bergamo, Italy. Grittip@libero.it
Carrara
B
B
Khotcholava
M
M
Bortolotti
G
G
Giardini
D
D
Lanterna
L A
LA
Benigni
A
A
Sonzogni
V
V
D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D000077335:Desflurane; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D010880:Piperidines / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology*; D000077208:Remifentanil; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy
D004338:Drug Combinations; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D015742:Propofol