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Thymic Surgery and Paraendocrine Syndromes

  • Daniel Sellers
  • Karen McRaeEmail author
Chapter

Abstract

Myasthenia gravis is a complex autoimmune disease, the pathogenesis of which involves hypertrophy or tumor of the thymus gland. We review recent advances in our understanding of the autoimmune basis of the disease and the place of thymectomy for malignant and nonmalignant disease. We review considerations for anesthetizing the patient with myasthenia gravis, with particular emphasis on the problems of the anterior mediastinal mass, management of muscle relaxants and anticholinesterases, prediction of postoperative ventilatory failure, and differentiation of myasthenic vs cholinergic crisis. We also describe the Lambert-Eaton myasthenic syndrome, with particular reference to the differences in presentation and management compared to myasthenia gravis. Carcinoid syndrome is an infrequently occurring problem in thoracic surgery but potentially serious and difficult to manage without experience, so we review the pathogenesis and clinical presentation of carcinoid syndrome and its prophylaxis and specific treatment with octreotide and serotonin antagonists.

Keywords

Myasthenia Carcinoid syndrome Respiratory failure Heart disease Surgery 

Abbreviations

ACTH

Adrenocorticotrophic hormone

CRH

Corticotrophin-releasing hormone

CT

Computed tomography

CVP

Central venous pressure

ECG

Electrocardiogram

GHRH

Growth-hormone-releasing hormone

IVIG

Intravenous immunoglobulin

LES

Lambert-Eaton syndrome

LRP-4

Lipoprotein receptor-related protein 4

MEN

Multiple endocrine neoplasia

MG

Myasthenia gravis

MGFA

Myasthenia Gravis Foundation of America

MuSK

Muscle-specific kinase

NDMR

Nondepolarizing muscle relaxants

NMJ

Neuromuscular junction

SCLC

Small cell lung cancer

SIADH

Syndrome of inappropriate release of antidiuretic hormone

TEA

Thoracic epidural anesthesia

TIVA

Total intravenous anesthesia

TSH

Thyroid-stimulating hormone

VATS

Video-assisted thoracic surgery

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Anesthesia and Pain ManagementToronto General Hospital, University Health NetworkTorontoCanada

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