title: Anaesthesia for thymectomy in adult and juvenile myasthenic patients.
abstract: OBJECTIVE
  Myasthenia gravis, a chronic disease of the neuromuscular junction, is associated with an interaction with neuromuscular blocking agents (NMBAs). As thymectomy is often the method of choice for its treatment, anaesthetic management requires meticulous preoperative evaluation, careful monitoring, and adequate dose titration. The frequency of video-assisted thoracoscopic extended thymectomy (VATET) is also increasing, making the use of NMBA obligatory. The number of cases of the juvenile form has also increased over years; airway management in juvenile one-lung ventilation is another challenge.
  
  
  RESULTS
  Sugammadex appears to be a safe choice to avoid prolonged action of NMBA also in patients with myasthenia gravis, although this information has to be confirmed in further series. The number of VATETs is increasing so that the experience with sugammadex will also increase in time. In non-VATET operations, use of NMBA should and can be avoided as much as possible. New scoring systems are defined to predict a postoperative myasthenic crisis. For VATET in juvenile cases, blockers can be a good option for the airway management.
  
  
  CONCLUSIONS
  Anaesthetic management of thymectomy in myasthenia gravis requires experience concerning different approaches. Sugammadex should be considered as a possible further step toward postoperative safety.
authors.affiliation: Department of Anaesthesiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Zerrin
authors.initials: Z
authors.lastname: Sungur
authors.forename: Mert
authors.initials: M
authors.lastname: Sentürk
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D006801:Humans; D009157:Myasthenia Gravis / Q000601:surgery*; D009466:Neuromuscular Blocking Agents; D061810:One-Lung Ventilation; D011183:Postoperative Complications / Q000517:prevention & control*; D000077122:Sugammadex; D013906:Thoracoscopy; D013934:Thymectomy; D047408:gamma-Cyclodextrins
chemical_list: D009466:Neuromuscular Blocking Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex