Abstract
Thymectomy and mediastinal surgery entails a number of potentially severe perioperative concerns and complications. While thymectomies are a less common procedure, the disease progression necessitating such an intervention further complicates anesthetic management. The surgical approach varies widely depending on the age, size, and location of the lesion involved and the anesthetic plan therefore diversifies to accommodate. This chapter discusses the clinical presentation and potential complications that arise, in order to safely implement a perioperative plan. Due consideration is applied to unique concerns in and out of the operative setting to optimize patients for surgery and mitigate potential severe adverse outcomes. Table 17.1 provides a summary of the considerations for providing anesthesia to patients undergoing thymectomy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Engels EA. Epidemiology of thymoma and associated malignancies. J Thorac Oncol. 2010;5(10 Suppl 4):S260–5.
Lucchi M, Van Schil P, Schmid R, Rea F, Melfi F, Athanassiadi K, Zielinski M, Treasure T. Thymectomy for thymoma and myasthenia gravis. A survey of current surgical practice in thymic disease amongst EACTS members. Interact Cardiovasc Thorac Surg. 2012;14(6):765–70.
Couture MM, Mountain CF. Thymoma. Semin Surg Oncol. 1990;6:110–4.
Rosa GR, Takizawa N, Schimidt D, Sugita M. Surgical treatment of superior vena cava syndrome caused by invasive thymoma. Rev Bras Cir Cardiovasc. 2010;25(2):257–60.
Phillips LH. The epidemiology of myasthenia gravis. Ann N Y Acad Sci. 2003;998:407–12.
Tuzun E, Christadoss P. Complement associated pathogenic mechanisms in myasthenia gravis. Autoimmun Rev. 2013;12(9):904–11.
Bril V, Kojic J, Ilse WK, Cooper JD. Long-term clinical outcome after transcervical thymectomy for myasthenia gravis. Ann Thorac Surg. 1998;65(6):1520–2.
Souadjian JV, Enriquez P, Silverstein MN, Pepin JM. The spectrum of diseases associated with thymoma: coincidence or syndrome? Arch Intern Med. 1974;134(2):374–9.
Crowe JK, Brown LR, Muhm JR. Computed tomography of the mediastinum. Radiology. 1978;128(1):75–87.
Baron RL, Lee JK, Sagel SS, Levitt RG. Computed tomography of the abnormal thymus. Radiology. 1982;142:127–34.
Azizkhan RG, Dudgeon DL, Buck JR, et al. Life-threatening airway obstruction as a complication to the management of mediastinal masses in children. J Pediatr Surg. 1985;20:816–22.
Pravash UBS, Abel MD, Hubmayr RD. Mediastinal masses. A case report and review of the literature. Anaesthesia. 1984;39:899–903.
Giannopoulou A, Gkiozos I, Harrington KJ, Syrigos KN. Thymoma and radiation therapy: a systematic review of medical treatment. Expert Rev Anticancer Ther. 2013;13(6):759–66.
Dillon F. Anesthesia issues in the perioperative management of myasthenia gravis. Semin Neurol. 2004;24(1):83–94.
Neuman GG, Weingarten AE, Abramowitz RM. The anesthetic management of the patient with an anterior mediastinal mass. Anesthesiology. 1984;60:144–7.
Shrager JB, Deeb ME, Mick R, et al. Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg. 2002;74:320–6.
Tsunezuka Y, Oda M, Matsumoto I, Tamura M, Watanabe G. Extended thymectomy in patients with myasthenia gravis with high thoracic epidural anesthesia alone. World J Surg. 2004;28(10):962–5.
Baraka A, Baroody M, Yazbeck V. Repeated doses of suxamethonium in the myasthenic patient. Anaesthesia. 1993;28:782–4.
Yanagidate F, Dohi S, Hamaya Y, Tsujito T. Reexpansion pulmonary edema after thorascopic mediastinal tumor resection. Anesth Analg. 2001;92(6):1416–7.
Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55(1):7–15.
Lin M, Chang Y, Huang P, Lee Y. Thymectomy for non-thymomatous myasthenia gravis: a comparison of surgical methods and analysis of prognostic factors. Eur J Cardiothorac Surg. 2010;37:7–12.
Kim HK, Park MS, Choi YS, et al. Neurologic outcomes of thymectomy in myasthenia gravis: comparative analysis of the effect of thymoma. J Thorac Cardiovasc Surg. 2007;134(3):601–7.
Ng JK, Ng CS, Underwood MJ, Lau KK. Does repeat thymectomy improve symptoms in patients with refractory myasthenia gravis. Interact Cardiovasc Thorac Surg. 2014;18(3):376–80.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Hoffman, C.R., Green, M.S. (2018). Anesthesia for Thymectomy. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_17
Download citation
DOI: https://doi.org/10.1007/978-3-319-74766-8_17
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-74765-1
Online ISBN: 978-3-319-74766-8
eBook Packages: MedicineMedicine (R0)