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Anesthesia for Transcervical Thymectomy in Myasthenia Gravis

DIGVIJAY S. GIRNAR, MD^*, and AVRON I. WEINREICH, MD

*Resident in Anesthesiology, Mount Sinai School of Medicine of the City University of New York and the Mount Sinai Hospital, New York, New York 10029. Associate Clinical Professor, Department of Anesthesiology, Mount Sinai School of Medicine of the City University of New York and the Mount Sinai Hospital, New York, New York 10029.

Abstract

This review of anesthetic experience in 100 cases of transcervical thymectomy for myasthenia gravis (MG) at The Mount Sinai Hospital (1970--1974) underlines current trends in the surgical management at Mount Sinai, where transcervical thymectomy is the procedure of choice for all patients with nonthymomatous MG and for selected patients with thymomatous MG. The transthoracic approach is now limited to malignant thymomas and tumors not accessible through the transcervical approach. Formerly, patients coming for thymectomy either already had a preexisting tracheostomy, or an elective tracheostomy was performed at the time of thymectomy. Since 1972, none of these patients has had elective tracheostomy at the time of operation, and only four were performed in the postoperative period, patients being intubated orotracheally at the time of operation. The tube is usually removed within 1 hour after completion of thymectomy. All patients are followed in the intensive care unit for 24 hours or longer, under close supervision of experienced personnel aware of the inherent problems and able to assist ventilation at any stage. This approach has greatly changed the postoperative course of this disease.