Propofol TCI or sevoflurane anesthesia without muscle relaxant safe for thoracoscopic thymectomy in myasthenia gravis patients

In a recent study conducted at a university hospital, researchers have made significant strides in improving the safety of anaesthesia for myasthenia gravis (MG) patients undergoing thoracoscopic thymectomy. Anaesthesia with propofol TCI or sevoflurane, without the use of muscle relaxants, was shown to provide safe and effective conditions for the surgical procedure.

This study was published in BMC Anaesthesiology by Vo Van Hien and colleagues. This research explores the effectiveness of general anesthesia without the use of muscle relaxants, utilizing either propofol through target-controlled infusion systems (TCI) or sevoflurane. This prospective, open-label, observational study included 90 myasthenic patients who underwent thoracoscopic thymectomy under general anesthesia. Two anesthesia methods were compared:

• Group P (Propofol TCI): This group consisted of 45 patients who received both induction and maintenance anesthesia with propofol via target-controlled infusion systems.
• Group S (Sevoflurane): The other 45 patients received induction with propofol (2–3 mg.kg−1) and maintenance anesthesia with sevoflurane.
  

Key Numerical Results:

• Intubation Conditions: All 90 patients across both groups achieved excellent intubation conditions, ensuring a safe start to the procedure.
• Hemodynamic Stability: Hemodynamic instability was more frequent in group S (sevoflurane) than in group P (propofol TCI). However, this instability was manageable.
  
• Neuromuscular Transmission: The study revealed significant differences in intraoperative muscular relaxation:
  
• In group S, the reduction in the intraoperative train-of-four ratio from baseline was 10.3% at 30 minutes, 14.2% at 60 minutes, and 14.3% at 90 minutes.
• In group P, the reduction was notably lower, with figures of 6.8%, 7.2%, and 8.4% at the same time intervals.
• Extubation and Complications: All 90 patients were successfully extubated in the operating room without complications, ensuring a safe and smooth recovery process.

This study offers a promising approach to anesthesia for MG patients undergoing thoracoscopic thymectomy. While sevoflurane achieved higher levels of intraoperative muscular relaxation, both anesthesia methods had no adverse effects on postoperative neuromuscular function. The findings of this research have significant implications for the anesthesia management of MG patients and could potentially lead to improved outcomes and reduced risks during thoracoscopic thymectomy. Future studies may further refine the choice of anesthesia method and explore its application in broader clinical settings.

Reference:

Van Hien, V., Tu, N. H., & Thu, N. D. Propofol TCI or sevoflurane anesthesia without muscle relaxant for thoracoscopic thymectomy in myasthenia gravis patients: a prospective, observational study. BMC Anesthesiology,2023;23(1). https://doi.org/10.1186/s12871-023-02296-6