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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recommendations concerning postoperative extubation after thymectomy for myasthenia gravis are presently based upon retrospective chart reviews. We present the results of a prospective investigation of time to extubation after thymectomy for 14 patients over a 12-month period based upon a protocol that included preoperative immunologic therapy, combined epidural and general anesthesia, postoperative epidural narcotic analgesia, and a standardized approach to discontinuation of ventilatory support. After a neurologist took measures to optimize preoperative neuromuscular function, all 14 patients received agents to produce lumbar epidural anesthesia and light general anesthesia. Muscle relaxants were avoided in all but one patient. Postoperative analgesia was initially maintained with epidural hydromorphone, then therapy was switched to patient-controlled intravenous morphine sulfate. Criteria for weaning from mechanical ventilation, first measured at the end of anesthesia, were partial pressure of oxygen (arterial) greater than or equal to 90 mm Hg (fraction of inspired oxygen = 0.40), partial pressure of carbon dioxide (arterial) less than or equal to 50 mm Hg, pH greater than or equal to 7.30, and respiratory rate less than or equal to 30 breaths/min. If these criteria were not met, ventilatory support was continued postoperatively with intermittent mandatory ventilation, and the patient was weaned gradually from this support. Criteria for extubation included meeting the criteria for weaning, vital capacity greater than or equal to 10 mL/kg, and inspiratory pressure better than -30 cm H2O. Criteria for reintubation included tachypnea (respiratory rate greater than 40 breaths/min), respiratory acidosis not due to narcotics, or vital capacity less than or equal to 8 mL/kg. The mean time to extubation was 9 hours (range, 0.75 to 25 hours). Mean preoperative vital capacity was 2.59 +/- 0.64 L (range, 1.90 to 4.20), which decreased approximately 50% to 1.19 +/- 0.39 L (range, 0.70 to 2.0) at the time of extubation. No patient required reintubation. Half of the patients required postoperative anticholinesterase therapy based upon serial neurologic examinations; there were no instances of cholinergic crisis. Thirteen patients returned to the ward on the first postoperative day, and one on the second day. Thirteen patients preferred epidural analgesia to patient-controlled analgesia. The time to extubation and average length of stay in an intensive care setting were markedly reduced compared to those reported in previous retrospective studies. We conclude that a multidisciplinary approach that optimizes neuromuscular function and decreases poststernotomy pulmonary insult will shorten the time to extubation and decrease the length of stay in the intensive care or recovery room after thymectomy.
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PMID:Extubation after transsternal thymectomy for myasthenia gravis: a prospective analysis. 171 Dec 40

Postoperative respiratory management in a patient with myasthenia gravis is a difficult problem because of underlying muscle weakness, residual effects of anesthesia, and incisional pain. Use of intrathecal morphine reduces the amount of inhalation agent needed and provides analgesia for the first postoperative day, leading to a prompt, smooth emergence and easy extubation.
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PMID:Intrathecal morphine for thymectomy in a morbidly obese patient with myasthenia gravis. 201 Jun 63

The present review updates myasthenia gravis. Immunopathogenesis of this condition, the clinical picture and degrees of involvement according to Osserman's classification, diagnostic procedures currently available, medical treatment and repercussion on the patient who is going yo be thymectomized are discussed. We review the works of several authors as far as concern to the use of muscle relaxants in myasthenic patients, peroperative monitoring of neuromuscular blockade, anesthetic techniques to be used, analgesia and intensive care required during postoperative period.
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PMID:[Myasthenia gravis]. 209 61

Analgesia is an important problem in myasthenia gravis patients who have undergone transsternal thymectomy. Postoperative pain interferes with pulmonary function, which is already limited by the disease. The choice of medication is restricted because many analgesics are synergic to the myasthenia gravis syndrome and detrimental to the patient. Three patients with severe myasthenia gravis are presented who had undergone transsternal thymectomy with good postoperative results. They received high thoracal epidural anesthesia (C7-Th1/Th1-Th2/Th2-Th3) with a solution of bupivacaine and morphine (20 ml 0.25% bupivacaine with 10% morphine). The patients were extubated in the first 48 hours and monitoring of respiratory function (CV2, PO2, PCO2) showed satisfactory values. With this type of analgesia we obtained early mobilization and good patient cooperation. Although limited this favourable experience confirms that high thoracal epidural anesthesia is a sure technique which allows rapid weaning from the ventilator and maximum comfort for the patient. It avoids the use of other medication or analgesics which are contraindicated in these patients.
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PMID:[Can one use high thoracic epidural analgesia in postoperative intensive care of the myasthenia patient following trans-sternal thymectomy?]. 357 55

A modified technique of total intravenous anaesthesia was used in the management of 22 patients with myasthenia gravis of varying severity undergoing therapeutic transcervical thymectomy. The relatively short-acting intravenous hypnotics, Althesin and etomidate were compared for induction of anaesthesia and for maintenance as a supplement to 50% nitrous oxide in oxygen. Moderately high doses (20 or 25 micrograms/kg) of the potent, synthetic opiate, fentanyl provided analgesia and a level of respiratory depression sufficient to facilitate control of respiration. The induction of anaesthesia was rapid and smooth, completed in under 5 minutes. Reflex response to surgical stimulation was suppressed for extremely variable periods. Complete recovery of consiousness, or adequate spontaneous respiration and of muscle tone was readily achieved, but was more rapid after Althesin (p less than 0.05). Postoperative problems were few. It is suggested that this technique of anaesthesia can provide optimum operating conditions with rapid, complete recovery and consequently low morbidity; the primary requirements of anaesthesia for therapeutic thymectomy.
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PMID:Anaesthesia for transcervical thymectomy in myasthenia gravis. 648 65

A 76 year-old myasthenic patient with acute biliary obstruction underwent operation under light general anaesthesia combined with a continuous thoracic epidural block. This combination proved to offer good relaxation, analgesia, amnesia and inhibition of reflexes during operation and pain relief postoperatively, without the need of muscle relaxants and narcotics. The patient showed no signs of postoperative weakness due to myasthenia gravis.
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PMID:[Thoracic epidural block for upper abdominal surgery in a patient with myasthemia gravis (author's transl)]. 739 36

We present a patient with myasthenia gravis who was safely managed by epidural anesthesia during and after thymectomy. An epidural catheter was inserted via the C7-T1 intervertebral space and 2% lidocaine was used during the surgery. The level of analgesia as determined by pinprick extending from C5 to T6. Epidural morphine or morphine and bupivacaine were used for postoperative pain relief. We evaluated ventilatory responses to CO2 and hypoxia after epidural anesthesia with lidocaine or morphine, and during continuous epidural infusion of the mixture of morphine and bupivacaine. Ventilatory responses to CO2 and hypoxia were both depressed following epidural injection of morphine. However, depression of ventilatory responses was not demonstrated following continuous epidural infusion of a mixture of morphine and bupivacaine. This case report suggests that epidural anesthesia is useful as a primary anesthetic and for postoperative pain control in patients with myasthenia gravis.
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PMID:Epidural anesthesia in a patient with myasthenia gravis. 835 67

Forty-seven myasthenia gravis patients undergoing transsternal thymectomy were allocated into 2 groups. Group 1 which consisted of 27 patients was anesthetized using the balanced technique, while 20 patients in group 2 received the combination of thoracic and balanced anethesia. The ventilation was controlled through the endotracheal tube in both groups. The extubation criteria after performing the surgery were good consciousness, adequate muscle strength and adequate respiration. There were 29.2 per cent in group 1 but 77.8 per cent in group 2 (P = 0.002) with successful extubation immediately postoperation. Morphine 15.4 +/- 5.3 mg intramuscularly in group 1, and 6.5 +/- 1.2 mg epidurally in group 2 (P < 0.001) was given for postoperative analgesia. Adequacy of respiration was observed postoperatively in the intensive care unit (ICU). Group 1 patients required 76.9 per cent of further ventilatory support for the period of 37.11 +/- 39.54 hours and duration of the ICU stay was 65.52 +/- 85.84 hours, whereas, the patients in group 2 showed significantly different results, which were 15.8 per cent of ventilatory support (P = 0.002) for 10.33 +/- 6.03 hours (P = 0.014) and 22.8 +/- 8.06 hours for staying in ICU (P = 0.021). This study demonstrated that the combined thoracic epidural with light general anesthesia provides excellent intraoperative anesthesia together with postoperative analgesia, which reduces the need for postoperative respiratory support, as well as decreases the hospital cost.
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PMID:Combined thoracic epidural with light general anesthesia for thymectomy in myasthenia gravis. 857 72

Thoracic surgical oncology involves surgical treatment of lesions of the thoracic wall, pulmonary parenchyma, or mediastinum (also including heart, esophagus, or trachea). The most common neoplasms of the thoracic wall are osteosarcoma and chondrosarcoma. Histopathologic type, the use of chemotherapy for osteosarcoma, and completeness of surgical margins are prognostic for survival. Relative to solitary pulmonary masses, carcinomas are most common, with histopathologic type, tumor size, tumor grade, and lymph node status prognostic for survival. Of the aforementioned variables, lymph node status is the most significant. Extensive preoperative workup, including bronchoscopy and transthoracic fine needle aspiration of solitary lung masses, is usually not recommended. Thymomas are the most common surgical mediastinal mass. Patients are frequently affected with paraneoplastic syndromes including myasthenia gravis, polymyositis, and nonthymic neoplasia. Patients without megaesophagus with surgically resectable masses have an excellent prognosis for survival. Provision of analgesia after surgery in thoracotomy patients is extremely important. Carefully selected analgesic agents in thoracotomy patients are far less damaging to cardiovascular status than is tachycardia from excessive pain. Given these and other guidelines, perioperative mortality in thoracotomy patients is minimal, and long-term survival in selected patients is excellent.
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PMID:Thoracic surgical oncology. 963 48

A young female whose pyridostigmine treatment had recently been changed presented with myasthenia gravis, acute respiratory failure, and respiratory infection. She was supported with a noninvasive negative pressure cuirass device as an aid to optimizing medical therapies without the confounding factor of pharmacology-induced sedation and analgesia.
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PMID:Respiratory failure in myasthenia gravis and negative pressure support. 980 42


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