Trans-sternal thymectomy in myasthenia gravis patients with laryngeal mask airway

ABSTRACT

TUIP is as effective as TURP in achieving maximum flow rate but TUIP was superior in terms of shorter operative time, less retrograde ejaculation and less need of blood transfusion. A descriptive case series. Department of Anaesthesia, Jinnah Postgraduate Medical Centre Karachi, from June 2006 to December 2010. All patients who underwent trans-sternal thymectomy for myasthenia gravis under laryngeal mask airway [Prosea] were included. They were maintained with inhalation agent and analgesics. Muscle relaxants were avoided in all the patients. The haemodynamics and blood gases were monitored perioperatively. A total of sixteen patients underwent the procedure using laryngeal mask airway [Proseal]. There were ten females and 6 males. Mean age at presentation was 26.5 +/- 10.4 year. The haemodynamics and blood gases were well maintained perioperatively. Fourteen patients [87.5%] could be extubated successfully. Two patients needed intubation and ventilation; one for 9 hours and other for 24 hours. These patients were identified as those who were on higher doses of pyridostigmine [>240 mg] and had severe pre-operative muscle weakness. The use of laryngeal mask airway [Prosea] for patients undergoing trans-sternal thymectomy is a satisfactory alternative to tracheal intubation for those patients of myasthenia gravis who do not require airway protection. Avoidance of muscle relaxants and use of laryngeal mask airway [prosea] in facilitate rapid emergence and allowed early extubation