title: Preoperative low-dose steroid can prevent respiratory insufficiency after thymectomy in generalized myasthenia gravis.
abstract: BACKGROUND
  Postoperative respiratory insufficiency (PRI) in myasthenia gravis (MG) often occurs within several days after thymectomy and remains problematic. In limited studies reporting that preoperative steroids prevented PRI in patients with MG, high doses of steroids were used and detailed information on the use of steroids is limited. Because high-dose steroids significantly increase the risk of adverse effects, we studied 37 patients with generalized MG to investigate whether low-dose steroids might prevent PRI.
  
  
  METHODS
  The low-dose steroids were started orally, and the dose was gradually increased to the maximum level (30 mg/day). Immediately before thymectomy, patients received the maximum dose of oral steroids daily. PRI was defined as the development of restrictive dysfunction requiring mechanical ventilation within 3 days after thymectomy and total postoperative mechanical ventilation support time of >24 h.
  
  
  RESULTS
  The rate of PRI in the low-dose steroid use group was significantly lower than that in the no-steroid use group. The postoperative stay in the intensive care unit was shorter in the steroid use group.
  
  
  CONCLUSIONS
  Extended thymectomy is a well-accepted surgical treatment for selected patients with MG. However, PRI remains problematic. Our results suggest that not only preoperative high-dose steroid treatment, but also low-dose steroid treatment can prevent PRI.
authors.affiliation: Department of Neurology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kataoka
authors.forename: Takao
authors.initials: T
authors.lastname: Kiriyama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Sugie
authors.forename: Hirosei
authors.initials: H
authors.lastname: Horikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Tojo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ueno
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000188:drug therapy / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*; D013934:Thymectomy / Q000009:adverse effects*
chemical_list: D013256:Steroids