Roohina N Baloch, Nasir Khan Jakhrani, Shahneela Raza, Erum Zeb.
Trans-sternal thymectomy in myasthenia gravis patients with laryngeal mask airway.
J Surg Pak Jan ;17(3):98-102.

Objective: To demonstrate the safety and efficacy of laryngeal mask airway (Proseal™) in patients undergoing trans-sternal thymectomy for myasthenia gravis. Study design: A descriptive case series. Place & Duration of study: Department of Anaesthesia, Jinnah Postgraduate Medical Centre Karachi, from June 2006 to December 2010. Methodology: All patients who underwent trans-sternal thymectomy for myasthenia gravis under laryngeal mask airway (Proseal™) 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. Results: 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. Conclusions: The use of laryngeal mask airway (Proseal™) 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 (proseal™) in facilitate rapid emergence and allowed early extubation.

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