title: [Predictive analysis for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis].
abstract: BACKGROUND
  The risk factors for postoperative myasthenic crisis (MC) in patients with myasthenia gravis (MG) receiving preoperative corticosteroids were unknown.
  
  
  METHODS
  Sixty-three consecutive patients who had undergone a transsternal thymectomy for MG were retrospectively analyzed. Of these, 59 patients (93.7%) received preoperative corticosteroids (prednisolone 1-2 mg x kg(-1)) every-other day. In this study, our definition of postoperative-MC was the need for prolonged postoperative mechanical ventilation for more than 48 hours. Six patients (9.5%) met this criterion. The patient background, and preoperative as well as intraoperative management were evaluated to identify risk factors for postoperative-MC.
  
  
  RESULTS
  Student's t-test revealed that the lengths of the operation and anesthesia were significantly longer in the postoperative-MC group compared with the control group (P < 0.05). Fisher's exact test revealed that the existence of preoperative bulbar symptoms and incomplete resection of the thymus gland were also more common in the postoperative-MC group (P < 0.05). A logistic regression analysis revealed that the existence of preoperative bulbar symptoms was the only significant risk factor for postoperative-MC.
  
  
  CONCLUSIONS
  Based on this study, we concluded that the existence of preoperative bulbar symptoms seems to be a predictor for the development of postoperative-MC in patients with MG undergoing a transsternal thymectomy.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Shimotsuke 329-0498.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Koinuma
authors.forename: Shin
authors.initials: S
authors.lastname: Nunomiya
authors.forename: Masahiko
authors.initials: M
authors.lastname: Wada
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Misawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kansuke
authors.initials: K
authors.lastname: Koyama
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D005260:Female; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000209:etiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011239:Prednisolone / Q000008:administration & dosage; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013934:Thymectomy / Q000379:methods*; D013997:Time Factors
chemical_list: D011239:Prednisolone