Objective
Postoperative myasthenic crisis with respiratory failure is a potentially lethal complication,
warranting careful perioperative planning and extended postoperative surveillance
of patients. Data on the incidence of postoperative respiratory failure and optimal
management of patients after robotic-assisted thymectomy are limited.
The objective of this study was to evaluate the incidence of respiratory complications
and the need for intensive care unit (ICU) capacities after robotic-assisted thymectomy
in patients with myasthenia gravis.
Design
Retrospective cohort study.
Setting
Single University hospital in Vienna, Austria, from January 2014 to December 2019.
Participants
The authors included adult patients who underwent robotic-assisted thymectomy due
to myasthenia gravis.
Main Results
Of 72 patients, 4 patients (5.6%) developed postoperative respiratory failure, needing
noninvasive ventilation/intubation. Respiratory failure occurred within the first
hours after extubation when patients still were under surveillance in the recovery
room or in the ICU. One patient (1.4%) suffered from worsened myasthenic symptoms
several days after surgery, and was treated with plasmapheresis. Sixty-five patients
(90.3%) were extubated in the operating room, 35 of these (48.6%) were transferred
to the ICU, and 30 patients (41.7%) primarily were transferred to the recovery room.
Fourteen patients (19.4%) were transferred to the surgical ward after extended observation
in the recovery room. Furthermore, after implementation of a standardized perioperative
algorithm in 2020, a reduction of ICU admissions was achieved.
Conclusions
After careful patient selection, planning, and postoperative patient evaluation, robotic-assisted
thymectomy can be performed safely without postoperative surveillance in an ICU.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Anesthesia and myasthenia gravis.Acta Anaesthesiol Scand. 2012; 56: 17-22
- Anesthesia for robotic thoracic surgery.Ann Cardiothorac Surg. 2019; 8: 263-268
- Initial experience with a combined sequential left-sided and subxiphoid video-assisted thoracic surgery approach for resection of large anterior mediastinal tumors.Mediastinum. 2018; 2: 58
- Myasthenia gravis.N Engl J Med. 2016; 375: 2570-2581
- Myasthenia gravis.Nat Rev Dis Primers. 2019; 5: 1-19
- International consensus guidance for management of myasthenia gravis: 2020 Update.Neurology. 2021; 96: 114-122
- International consensus guidance for management of myasthenia gravis: Executive summary.Neurology. 2016; 87: 419-425
- Robotic-assisted thymectomy: Current perspectives.Robot Surg. 2016; 3: 53-63
- Myasthenia gravis and thymoma surgery: A clinical update for the cardiothoracic anesthesiologist.J Cardiothorac Vasc Anesth. 2019; 33: 2537-2545
- Thymic minimally invasive surgery: State of the art across the world—Europe.J Vis Surg. 2017; 3: 70
- Long-term follow-up after robotic thymectomy for nonthymomatous myasthenia gravis.Ann Thorac Surg. 2011; 92: 1018-1023
- Fair allocation of scarce medical resources in the time of covid-19.N Engl J Med. 2020; 382: 2049-2055
- Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis.Ann Surg. 1997; 226: 324-335
- Transsternal radical thymectomy for myasthenia gravis: A 15-year review.Ann Thorac Surg. 1989; 47: 838-840
- Decade-long experience with surgical therapy of myasthenia gravis: Early complications of 324 transsternal thymectomies.Ann Thorac Surg. 2001; 72: 1691-1697
- A standardized protocol for the perioperative management of myasthenia gravis patients. Experience with 110 patients.Acta Anaesthesiol Scand. 2012; 56: 66-75
- Assessment of the risks of a myasthenic crisis after thymectomy in patients with myasthenia gravis: A systematic review and meta-analysis of 25 studies.J Cardiothorac Surg. 2020; 15: 270
- 8 Years’ experience with robotic thymectomy for thymomas.Surg Endosc. 2014; 28: 1202-1208
- Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis.J Thorac Cardiovasc Surg. 2013; 145: 730-736
- Thymectomy in myasthenia gravis: Proposal for a predictive score of postoperative myasthenic crisis.Eur J Cardiothorac Surg. 2014; 45: e76-e88
Article info
Publication history
Published online: May 22, 2022
Footnotes
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- A New Postthymectomy Care Algorithm—Postanesthesia Care Unit Versus Intensive Care Unit After Robotic-Assisted Thoracoscopic Surgery: Does It Make a Difference?Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 10
- PreviewMYASTHENIA GRAVIS (MG) is a rare autoimmune disease that is characterized by fluctuating muscle weakness due to autoantibodies against the acetylcholine receptor or other related functional molecules at the neuromuscular junction.1 Thymoma frequently is associated with several types of diseases, of which MG is the most common. It is diagnosed in 10% to 15% of these patients.2 Resection of the thymoma remains the main therapeutic strategy. In recent years, focus has shifted from thoracotomy and transsternal thymectomy toward minimally invasive approaches, including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS).
- Full-Text
- Preview
