Experience with programmed steroid treatment with thymectomy in nonthymomatous myasthenia gravis

Preoperative Low-Dose Steroid Can Prevent Respiratory Insufficiency After Thymectomy in Generalized Myasthenia Gravis

“…Maximum bleeding in the present study was 175 ml in a patient who has received steroids. ‘Respiratory insufficiency' was defined as restrictive dysfunction requiring mechanical ventilation occurring within 3 days after thymectomy in the absence of other accidental causes of postoperative cardiopulmonary complications, such as pulmonary embolism or severe pneumonia, and a total postoperative mechanical ventilation support time of >24 h [1,4,5,6,7,8,9,10,11]. The effects of anesthetic agents disappeared within a few hours after surgery, but respiratory insufficiency persisted beyond this period.…”

“…The reported incidence of PRI varies, but can be as high as 30-50% [1,2,3]. Preoperative treatment with steroids was previously reported to decrease the risk of PRI (table 1) [1,2,3,4,5,6,7,8,9,10,11] but detailed information on the use of steroids is very limited. Previous studies administered high doses of steroids (80-120 mg) daily or on alternate days before thymectomy [4,5,6,7,11] and included patients with ocular MG [5,6,7].…”

“…Preoperative treatment with steroids was previously reported to decrease the risk of PRI (table 1) [1,2,3,4,5,6,7,8,9,10,11] but detailed information on the use of steroids is very limited. Previous studies administered high doses of steroids (80-120 mg) daily or on alternate days before thymectomy [4,5,6,7,11] and included patients with ocular MG [5,6,7]. Many previous studies evaluating the usefulness of preoperative steroids (table 1) [1,4,5,6,7,8,9,10,11] included patients who received other preoperative treatments such as immunosuppressants, intravenous immunoglobulins, or plasmapheresis and showed that preoperative steroid use did not significantly decrease the risk of PRI [1,3,8,9].…”

“…Previous studies administered high doses of steroids (80-120 mg) daily or on alternate days before thymectomy [4,5,6,7,11] and included patients with ocular MG [5,6,7]. Many previous studies evaluating the usefulness of preoperative steroids (table 1) [1,4,5,6,7,8,9,10,11] included patients who received other preoperative treatments such as immunosuppressants, intravenous immunoglobulins, or plasmapheresis and showed that preoperative steroid use did not significantly decrease the risk of PRI [1,3,8,9]. Two studies showing that preoperative steroid use was significantly related to PRI included patients with ocular MG or patients who were given occasional steroid pulse therapy before thymectomy [5,6].…”

“…Because high-dose steroids significantly increase the risk of adverse effects such as glucose tolerance [4], osteoporosis [4], cataract [4], the problem of tissue healing [12] or surgical complications such as infection [6,8], we studied patients with generalized MG who had received low-dose steroids before thymectomy to investigate whether low-dose steroids might prevent PRI.…”