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Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients

[L’anesthésie au propofol ou au sévoflurane, sans myorelaxants, permet une extubation précoce chez des patients myasthéniques]

Giorgio Della Rocca, MD^*, Cecilia Coccia, MD^*, Laura Diana, MD, Livia Pompei, MD^*, Maria G. Costa, MD^*, Eleonora Tomaselli, MD, Pierangelo Di Marco, MD, Vincenzo Vilardi, MD^* and Paolo Pietropaoli, MD

^* From the Departments of Anesthesia, University of Udine, Udine;
The University Of Rome "la Sapienza", Rome Italy.

Address correspondence to: Prof. Giorgio Della Rocca, Corso Trieste 169/a, 00198 Rome, Italy. Phone: +39 0432 559500-1; Fax: +39 0432 559512/545526; E-mail: giorgio.dellarocca{at}dsc.uniud.it

Purpose: To compare two non-muscle relaxant anesthetic techniques in myasthenic patients undergoing trans-sternal thymectomy, evaluating the intra- and postoperative conditions including the early extubation in the operating room.

Methods: Sixty-eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized in two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (1–2 mg•kg^-1) and intubation performed after topical anesthesia of the airway with lidocaine. Anesthesia was maintained in the propofol group (36 patients) with a continuous propofol infusion (3–6 mg•kg^-1•hr^-1) and nitrous oxide and, in the sevoflurane group (32 patients), with sevoflurane (end-tidal 1–1.5%) in O₂:N₂O. Intubating conditions, hemodynamic changes, neuromuscular transmission, postoperative intensive care unit and hospital length of stay and complications were evaluated. Data were analyzed with repeated measure two-way analysis of variance (ANOVA), Chi square test and Student’s t test.

Results: Intubating conditions were good in all patients. There were no hemodynamic changes. All patients were extubated in the operating room and none had to be re-intubated for postoperative respiratory depression. Neuromuscular transmission showed minimal changes, more important in the sevoflurane group, and at the end of the procedure the recovery was complete in all patients. We did not observe any other significant differences between the two groups studied.

Conclusion: Our data show that these two anesthetic techniques allow the early extubation of myasthenic patients in the operating room.

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