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

ABSTRACT

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.