Postoperative ventilatory dependency following thymectomy for myasthenia gravis1
Edward D. Sivak, M.D.
Atul Mehta, M.D.
Maurice Hanson, M.D.
Delos M. Cosgrove, M.D.
Thymectomy for the treatment of selected patients with myasthenia gravis results in postoperative prolongation of ventilatory support. A retrospective review of 24 patients undergoing the procedure via midline sternotomy revealed that 17 (71%) were weaned from mechanical ventilation within 48 hours. In the remaining patients, chest wall pain and respiratory muscle weakness prolonged ventilatory support to four days while complications of pneumonia in 2 patients and hydropneumothorax in another patient prolonged support beyond four days. Additional observations suggested that choline-esterase inhibitor therapy is necessary to assist in weaning from mechanical ventilation even if this therapy is reduced from preoperative dosages.