Early extubation after thymectomy is good for the patients with myasthenia gravis

Chen, Li; Xie, Wei; Zheng, Danping; Wang, Siqi; Wang, Ganping; Sun, Jiaqi; Tai, Qiang; Chen, Zhenguang

doi:10.1007/s10072-019-03941-0

Cited by 12 publications

(11 citation statements)

References 26 publications

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“…Kas and colleagues reported that the incidence of pulmonary complications, especially ventilator-associated pneumonia (VAP) after thymectomy in MG patients is mostly due to prolonged mechanical ventilation [ 21 ]. Li Chen et al demonstrated in their analysis of 96 patients with MG undergoing thymectomy that, early extubation (<6 h) was associated with improved clinical outcomes, in particular with reduced risk of postoperative pulmonary infection and reduced ICU stay in comparison to those having late extubation (>6 h) [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience

Mohamed

Shehada²,

Brakel³

et al. 2022

JCM

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: Background: Robotic-assisted surgery is gaining more adaption in different surgical specialties. The number of patients undergoing robotic-assisted thymectomy is continuously increasing. Such procedures are accompanied by new challenges for anesthesiologists. We are presenting our primary anesthesiologic experience in such patients. Methods: This is a retrospective single center study, evaluating 28 patients who presented with thymoma or myasthenia gravis (MG) and undergone minimal invasive robotic-assisted thoracic thymectomy between 01/2020–01/2022. We present our fast-track anesthesia management as a component of the enhanced recovery program and its primary results. Results: Mean patient's age was 46.8 ± 18.1 years, and the mean height was 173.1 ± 9.3 cm. Two-thirds of patients were female (n = 18, 64.3%). The preoperative mean forced expiratory volume in the first second (FEV1) was 3.8 ± 0.7 L, forced vital capacity (FVC) was 4.7 ± 1.1 L, and the FEV1/FVC ratio was 80.4 ± 5.3%. After the creation of capnomediastinum, central venous pressure and airway pressure have been significantly increased from the baseline values (16.5 ± 4.9 mmHg versus 13.4 ± 5.1 mmHg, p < 0.001 and 23.4 ± 4.4 cmH2O versus 19.3 ± 3.9 cmH2O, p < 0.001, respectively). Most patients (n = 21, 75%) developed transient arrhythmias episodes with hypotension. All patients were extubated at the end of surgery and discharged awake to the recovery room. The first 16 (57.1%) patients were admitted to the intensive care unit and the last 12 patients were only observed in intermediate care. Postoperatively, one patient developed atelectasis and was treated with non-invasive ventilation therapy. Pneumonia or reintubation was not observed. Finally, no significant difference was observed between MG and thymoma patients regarding analgesics consumption or incidence of complications. Conclusion: Robotic-assisted surgery is a rapidly growing technology with increased adoption in different specialties. Fast-track anesthesia is an important factor in an enhanced recovery program and the anesthetist should be familiar with challenges in this kind of operation to achieve optimal results. So far, our anesthetic management of patients undergoing robotic-assisted thymectomy reports safe and feasible procedures.

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Section: Discussionmentioning

confidence: 99%

Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience

Mohamed

Shehada²,

Brakel³

et al. 2022

JCM

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“…4 In the retrospective studies group with patients with NMD, it was described that early extubation (<6 hours) after a thymectomy in myasthenia gravis crisis was related to a lower reintubation rate, lower postoperative pulmonary infection and shorter duration of ICU stay compared with late extubation (>6 hours). 33 Another interesting factor associated with prolonged mechanical ventilation and tracheostomy prolonged need in these patients is neurogenic dysphagia. 34 And non-invasive ventilation was highlighted as a feasible intervention to be used after weaning failure with survival improvement and lower reintubation rate, 4 as well as instead of invasive mechanical ventilation and future weaning, where no mortality difference was noted.…”

Section: Discussionmentioning

confidence: 99%

Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review

et al. 2021

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ObjectiveThis systematic review aimed in assessing the effects of different weaning protocols in people with neuromuscular disease (NMD) receiving invasive mechanical ventilation, identifying which protocol is the best and how different protocols can affect weaning outcome success, duration of weaning, intensive care unit (ICU) and hospital stay and mortality.DesignSystematic review.Data sourcesElectronic databases (MEDLINE, EMBASE, Web of Science and Scopus) were searched from January 2009 to August 2020.Eligibility criteria for selecting studiesRandomised controlled trials (RCTs) and non-RCT that evaluated patients with NMD (adults and children from 5 years old) in the weaning process managed with a protocol (pressure support ventilation; synchronised intermittent mandatory ventilation; continuous positive airway pressure; ‘T’ piece).Primary outcomeWeaning success.Secondary outcomesWeaning duration, ICU stay, hospital stay, ICU mortality, complications (pneumothorax, ventilation-associated pneumonia).Data extraction and synthesisTwo review authors assessed the titles and the abstracts for inclusion and reviewed the full texts independently.ResultsWe found no studies that fulfilled the inclusion criteria.ConclusionsThe absence of studies about different weaning protocols for patients with NMD does not allow concluding the superiority of any specific weaning protocol for patients with NMD or determining the impact of different types of protocols on other outcomes. The result of this review encourages further studies.PROSPERO registration numberCRD42019117393.

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“…Several studies have suggested that early extubation can significantly reduce the risk of adverse events such as laryngotracheal injuries, pulmonary hypertensive crises, pulmonary atelectasis, and ventilator-acquired pneumonia [ 15 , 16 ]. A previous study also showed that early extubation could improve patients’ self-care abilities, accelerate the process of blood circulation in the lungs, and promote more rapid recovery in thoracic surgery [ 17 ]. The low incidence of complications after surgery in this study may partly be attributed to the early extubation of the laryngeal mask.…”

Section: Discussionmentioning

confidence: 99%

Nonintubated minimally invasive chest wall stabilization for multiple rib fractures: a prospective, single-arm study

Zhao

Chen

et al. 2020

World J Emerg Surg

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Background Nonintubated video-assisted thoracoscopic surgery has been widely reported in the past decade, while nonintubated chest wall stabilization has not been reported previously. The aim of this study was to evaluate the safety and feasibility of nonintubated minimally invasive chest wall stabilization in patients with multiple rib fractures. Methods We conducted a prospective, single-arm, observational study. In this prospective study, 20 consecutive patients with multiple rib fractures were treated using nonintubated minimally invasive chest wall stabilization. Results Minimally invasive chest wall stabilization was mostly performed for lateral rib fractures in this study (n = 8). The mean operation time was 92.5 min, and the mean blood loss was 49 ml. No patient required conversion to tracheal intubation. The mean extubation time of the laryngeal mask was 8.9 min; the mean postoperative fasting time was 6.1 h; the mean postoperative hospital stay was 6.2 days; the mean amount of postoperative drainage was 97.5 ml; the mean postoperative pain score was 2.9 points at 6 h, 2.8 points at 12 h, and 3.0 points at 24 h; and the mean postoperative nausea and vomiting score was 1.9 points at 6 h, 1.8 points at 12 h, and 1.7 points at 24 h. Conclusions Nonintubated minimally invasive chest wall stabilization is safe and feasible in carefully selected patients. Further studies with a large sample size are warranted. Trial registration ChiCTR1900025698. Registered on 5 September 2019.

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Early extubation after thymectomy is good for the patients with myasthenia gravis

Cited by 12 publications

References 26 publications

Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience

Anesthetic Management during Robotic-Assisted Minimal Invasive Thymectomy Using the Da Vinci System: A Single Center Experience

Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review

Nonintubated minimally invasive chest wall stabilization for multiple rib fractures: a prospective, single-arm study

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