Combined thoracic epidural with light general anesthesia for thymectomy in myasthenia gravis.

Forty-seven myasthenia gravis patients undergoing transsternal thymectomy were allocated into 2 groups. Group 1 which consisted of 27 patients was anesthetized using the balanced technique, while 20 patients in group 2 received the combination of thoracic and balanced anethesia. The ventilation was controlled through the endotracheal tube in both groups. The extubation criteria after performing the surgery were good consciousness, adequate muscle strength and adequate respiration. There were 29.2 per cent in group 1 but 77.8 per cent in group 2 (P = 0.002) with successful extubation immediately postoperation. Morphine 15.4 +/- 5.3 mg intramuscularly in group 1, and 6.5 +/- 1.2 mg epidurally in group 2 (P < 0.001) was given for postoperative analgesia. Adequacy of respiration was observed postoperatively in the intensive care unit (ICU). Group 1 patients required 76.9 per cent of further ventilatory support for the period of 37.11 +/- 39.54 hours and duration of the ICU stay was 65.52 +/- 85.84 hours, whereas, the patients in group 2 showed significantly different results, which were 15.8 per cent of ventilatory support (P = 0.002) for 10.33 +/- 6.03 hours (P = 0.014) and 22.8 +/- 8.06 hours for staying in ICU (P = 0.021). This study demonstrated that the combined thoracic epidural with light general anesthesia provides excellent intraoperative anesthesia together with postoperative analgesia, which reduces the need for postoperative respiratory support, as well as decreases the hospital cost.

Does furosemide prevent hypertension during perioperative splenectomy in thalassemic children?

Hemodynamic changes of 50 thalassemic children who had splenectomy under general anesthesia were compared to 40 identical patients who, in addition, received intravenous furosemide 1 mg/kg immediate preoperation. During the anesthetic process, both groups showed a significant increase of heart rate, systolic and diastolic blood pressure more than the preanesthetic values. Hemodynamic variables in the furosemide group declined toward normal range on termination of anesthesia, whereas, the other group's variables were still significantly higher than their control. During the first 24 hours postoperatively, 20 per cent of the furosemide group had blood pressure rising higher than 130/90 mmHg, while 18 per cent was observed in the other group. Antihypertensive drugs were given to reduce the blood pressure in both groups. None of the patients in the furosemide group demonstrated any abnormal neurological symptoms, but 3 out of 50 patients in the other group developed convulsion. We, therefore, conclude that circulatory volume reduction with furosemide does not prevent hypertension during perioperative splenectomy in thalassemic children. However, it's role in prevention of neurological abnormalities needs to be further investigated.

Hypertension perioperative splenectomy in thalassemic children.

We retrospectively studied the intraoperative hemodynamic changes in 100 thalassemic children undergoing general anesthesia for elective splenectomy. They were divided into 2 groups owing to the postoperative hemodynamic response. Eighty-four patients who had an unremarkable postoperative course were group 1, while 16 patients who developed immediate postoperative hypertension were group 2. There were no differences between the groups regarding age, body weight, sex, anesthetic time and operation time, except for the preoperative hematocrits of group 1 patients were slightly but significantly higher. Both groups similarly showed significant increase of the systolic as well as diastolic blood pressure throughout the anesthetic course. The heart rate was significantly increased at the beginning but declined to normal toward the end of the operation. Although none of the patients died postoperatively, all of group 2 patients needed aggressive treatment with diuretic and antihypertensive drugs. Despite the proper management, 3 of 16 patients developed convulsion and one of them had persistent neurological deficit. Since intraoperative and postoperative hypertension which commonly occur in these patients may lead to more serious neurological complications, the authors suggest that careful hemodynamic monitoring must be considered for all thalassemic children undergoing general anesthesia for splenectomy.