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Video-assisted thoracoscopic extended thymectomy in myasthenic children
Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgi...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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PAGEPress Publications
2013
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649743/ https://www.ncbi.nlm.nih.gov/pubmed/23667733 http://dx.doi.org/10.4081/pr.2013.e4 |
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author | Sonzogni, Rita Novellino, Lorenzo Benigni, Alberto Busi, Ilaria Khotcholava, Magda Spotti, Angelica Sonzogni, Valter |
author_facet | Sonzogni, Rita Novellino, Lorenzo Benigni, Alberto Busi, Ilaria Khotcholava, Magda Spotti, Angelica Sonzogni, Valter |
author_sort | Sonzogni, Rita |
collection | PubMed |
description | Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006–2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Rüsch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy. |
format | Online Article Text |
id | pubmed-3649743 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | PAGEPress Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-36497432013-05-10 Video-assisted thoracoscopic extended thymectomy in myasthenic children Sonzogni, Rita Novellino, Lorenzo Benigni, Alberto Busi, Ilaria Khotcholava, Magda Spotti, Angelica Sonzogni, Valter Pediatr Rep Article Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006–2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Rüsch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy. PAGEPress Publications 2013-03-07 /pmc/articles/PMC3649743/ /pubmed/23667733 http://dx.doi.org/10.4081/pr.2013.e4 Text en ©Copyright R. Sonzogni et al., 2013 This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Licensee PAGEPress, Italy |
spellingShingle | Article Sonzogni, Rita Novellino, Lorenzo Benigni, Alberto Busi, Ilaria Khotcholava, Magda Spotti, Angelica Sonzogni, Valter Video-assisted thoracoscopic extended thymectomy in myasthenic children |
title | Video-assisted thoracoscopic extended thymectomy in myasthenic children |
title_full | Video-assisted thoracoscopic extended thymectomy in myasthenic children |
title_fullStr | Video-assisted thoracoscopic extended thymectomy in myasthenic children |
title_full_unstemmed | Video-assisted thoracoscopic extended thymectomy in myasthenic children |
title_short | Video-assisted thoracoscopic extended thymectomy in myasthenic children |
title_sort | video-assisted thoracoscopic extended thymectomy in myasthenic children |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649743/ https://www.ncbi.nlm.nih.gov/pubmed/23667733 http://dx.doi.org/10.4081/pr.2013.e4 |
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