Thymectomy
Considerations
-
Indication usually Myasthenia Gravis
-
Risks: aspiration, perioperative respiratory failure, cholinergic or myasthenic crises
-
Treatments: immune suppression, plasmapheresis, pyridostigmine
-
Altered response to neuromuscular blocking drugs (NMBs):
-
Sensitive to NdMR (nondepolarizing muscle relaxants) and resistant to succinylcholine
-
-
-
Postoperative analgesia for median sternotomy
-
Potential need for lung isolation to improve surgical exposure
Goals/Conflicts
-
Preoperative assessment & optimization of myasthenia gravis patients: preoperative plasmapheresis, multidisciplinary discussion
-
Minimize risk of aspiration
-
Minimize risk of perioperative respiratory failure (judicious use of NMBs & opioids; epidural analgesia)
-
Minimize risk of myasthenic or cholinergic crisis
-
Discuss surgical approach with surgeon & need for lung isolation