1. ANESTHESIA FOR SURGERY OF THYMECTOMY TO TREAT
MYASTHENIA GRAVIS
AT CHORAY HOSPITAL FROM 2004 – 2012.
PhD.MD. Dong Pham Van
Dr. Thao Trang Nguyen Thi
THE ANESTHETIC
DEPARTEMENT

2. OVERVIEW

3. OVERVIEW
 AAnn aauuttooiimmmmuunnee ddiisseeaassee..
 AAggeess,, bbootthh sseexxeess,, ffeemmaallee >> mmaallee..
 HHiissttoorryy ooff mmuussccllee wweeaakknneessss,, mmoovvee iiss
ffaattiigguuee,, rreesstt iiss ggrraadduuaallllyy iimmpprroovveedd..
 1100 -- 1155%% ffoorr tthhyymmoommaass,, 7755%% ffoorr tthhyymmiicc
aabbnnoorrmmaalliittiieess..
 TThhyymmeeccttoommyy:: oonnee ooff eeffffiiccaacciioouuss tthheerraappiieess..

4. OVERVIEW
 General anesthesia with double-lumen
endotracheal tube, with or without NMBDs.
 Some drugs cause weak muscle.
 Vietnam hasn’t a lot of study topics like
this yet.
Purposes:
To investigate the correlation between 2 groups
patients with and without using NMBDs vs post-op
respiratory failure ratio and recoverable time after
anesthesia.

5. PHYSIOLOGY OF NEUROMUSCULAR
TRANSMISSIONS

6. MOTOR UNIT

7. PHYSIOLOGY OF NEUROMUSCULAR
TRANSMISSION
Stimulated neuron ®
openning Calci channel
® Ach from synaptic
vesicles in presynapse
terminal go out.
Ach – AchR ®
openning channel
® Na, Ca flows enter ®
depolarizing motor end
plate.
® Action potential
across on cell
membrane surface.

8. MECHANISM OF NMBDs
 Depolarizing NMBDs: linking AChR ®
Depolarize the end plate® phase I block
® prolonged connection of succinylcholin
® Deforming AchR structure ® phase II
block.
 Non-depolarizing NMBDs: linking with 1 a
unit ® abnormalities of Ach-AChR ® no
depolarize the end plate.

9. SSIITTEESS OOFF NNEEUURROOMMUUSSCCUULLAARR
TTRRAANNSSMMIISSSSIIBBLLEE DDYYSSFFUUNNCCTTIIOONN

10. EFFECTS OF NMBDs IN
NEUROMUSCULAR DYSFUNCTIONS
 DDeeccrreeaassiinngg tthhee nnuummbbeerr ooff AACChhRRss
bbeeccaauussee ooff::
• CChhaannggiinngg tthhee ffuunnccttiioonn ooff AACChhRRss ..
• IInnccrreeaassiinngg tthhee ddeeggrraaddaattiioonn ooff AACChhRRss..
• DDeessttrrooyyiinngg tthhee ssuurrffaaccee ooff ppoossttssyynnaappssee..
 RReessiissttaannccee wwiitthh ddeeppoollaarriizziinngg NNMMBBDDss..
 SSeennssiittiivviittyy wwiitthh nnoonn--ddeeppoollaarriizziinngg NNMMBBDDss..

11. SUBJECTS AND RESEARCH
METHODS

12. SUBJECTS AND RESEARCH
METHODS
Research design: retrospection, description with
analysis.
Time, place: at Cho Ray hospital from 03/2004 to
06/2012.
Surgical methods:Thymectomy by endoscopic
surgery.

13. SUBJECTS AND RESEARCH
METHODS
RReesseeaarrcchh mmeetthhooddss::
IInncclluussiioonn ccrriitteerriiaa:: IIIIAA,, IIIIBB ((OOsssseerrmmaann)),, 22
ggrroouuppss,, 11sstt ggrroouupp:: uussee NNMMBBDDss;; 22nndd ggrroouupp:: nnoo uussee
NNMMBBDDss..
EExxcclluussiioonn ccrriitteerriiaa:: ppaattiieennttss wwiitthh rreessppiirraattoorryy
ffaaiilluurree,, MMGG ccrriissiiss,, pprree--oopp ppyyrriiddoossttiiggmmiinnee
bbrroommiiddee >> 775500 mmgg//dd;; II,, IIIIII,, IIVV ggrraaddee;; IIIIAA,, IIIIBB wwiitthh
ccaarrddiiaacc,, cchhrroonniicc ppuullmmoonnaarryy ddiisseeaassee,, sseeqquueellaa ooff
ssttrrookkee..

14. SUBJECTS AND RESEARCH
METHODS
RReesseeaarrcchh pprroocceessss::
PPrreeaanneesstthheettiicc eexxaammiinnaattiioonn
PPrreeaanneesstthheettiicc ddrruuggss:: nnoo
IInndduuccttiioonn:: PPrrooppooffooll oorr sseevvoofflluurraannee,, SSuuffeennttaanniill,,
oorr ffeennttaannyyll ((IIVV)).. UUssee oorr nnoo uussee::
ssuuxxaammeetthhoonniiuummee,, aattrraaccuurriiuumm,, rrooccuurroonniiuumm..
IInnttuubbaattiinngg ddoouubbllee--lluummeenn ttuubbee....
MMaaiinntteennaannccee:: SSeevvoofflluurraannee,, iissoofflluurraannee,, TTIIVVAA
oorr TTCCII,, ssuuffeennttaanniill oorr ffeennttaannyyll ((IIVV)).. IInn eenndd ooff
ssuurrggeerryy,, ssttoopp ddrruuggss && cchhaannggee eennddoottrraacchheeaall
ttuubbee..
PPoosstt--oopp:: mmoonniittoorriinngg vviittaall ssiiggnnss,, AABBGG,, SSPPOO22,,
MMGG ccrriissiiss……aannaallggeessiiaa:: ttrraammaaddooll,, ppeerrffaallggaann,, oorr
nniissiiddooll..

15. SUBJECTS AND RESEARCH
METHODS
CCoolllleecctteedd vvaarriiaabblleess::
-- AAggee,, sseexx,, MMGG ddeeggrreeee,, ppuullssee,, BBPP,, SSppOO22..
-- SSuurrggiiccaall ttiimmee,, ttiimmee ooff ssppoonnttaanneeoouuss
vveennttiillaattiioonn vviiaa eennddoottrraacchheeaall ttuubbee,, rreeccoovveerryy
rroooomm,, iinn hhoossppiittaall.. RRaattiioo ooff rreessppiirraattoorryy ffaaiilluurree,,
ppoosstt--oopp mmeecchhaanniissmm vveennttiillaattiioonn..
-- PPeerriiooppeerraattiivvee ddrruuggss:: ffeennttaannyyll,, ssuuffeennttaanniill;;
pprrooppooffooll,, iissoofflluurraannee,, sseevvoofflluurraannee;;
ssuuxxaammeetthhoonniiuumm,, aattrraaccuurriiuumm,, rrooccuurroonniiuumm..
-- PPoosstt--oopp ddrruuggss:: ttrraammaaddooll..

16. RESULTS & DISCUSSIONS

17. RESULTS & DISCUSSIONS
124 patients
Table 1: Ratio of patients using
of relaxant drugs and no.
Table 2. Ratio of relaxant drugs.

18. DISTRIBUTION OF AGES, SEXES IN
02 GROUPS
Characteri
zations
1st Group
n = 43 (%)
2nd Group
n = 81 (%)
Total
n= 124(%)
P
Age X ± SD
Min
Max
30.33 ± 11.07
13
55
34.30 ± 11.65
14
62
32.16 ± 11.23
13
62
0.069
Sex Male
Female
10 (23.3%)
33 (76.7%)
27 (33.3%)
54 (66.7%)
37 (29.8%)
87 (70.2%)
< 0.001
Comments: 70.2% female, 29,8% male, this difference was statistically
significant, with p < 0.001. Average age was 32.16 ± 11.23, this difference wasn’t
statistically significant between 2 groups. p > 0.05.

19. SURGICAL TIME.
Time (minute) 1st group
(n = 43)
2nd group
(n = 81)
p
X ± SD
Min
Max
104 ± 52.11
45
190
96 ± 52.52
30
200
0.672
Comments: The surgical time wasn’t statictically significant difference
between 2 groups, with p > 0.05.

20. TIME OF SPONTANEOUS VENTILATION
VIA ENDOTRACHEAL TUBE IN
RECOVERY ROOM
1st Group 2nd Group
Comments: 1st group 21.61 ± 11.40 was longer 2nd group 5.69 ± 5.13, the
difference was statictically significant, with p < 0.001.

21. RATIO OF MECHANISM
VENTILATION IN RECOVERY ROOM
Mechanism
Ventilation
1st group
(n = 43)
2nd group
(n = 81)
p
Yes
No
9 (20.9)
34 (79.1)
6 (7.4)
75 (92.6)
0.028
Comments: : 1st group 20.9% was higher than 2nd group 7.4%, the
difference was statictically significant, with p < 0.05.

22. TTIIMMEE OOFF PPOOSSTT--OOPP MMEECCHHAANNIISSMM
VVEENNTTIILLAATTIIOONN BBEETTWWEEEENN 0022
GGRROOUUPPSS
56.06 ± 57.98
1st Group 2nd Group
Comments : 1st group 56.06 ± 57.98 was longer than 2nd group 3.50 ±
1.33, the difference was statictically significant, with p < 0.05.

23. POST-OP RESPIRATORY FAILURE
RATIO BETWEEN 02 GROUPS.
100
90
80
70
60
50
40
30
20
10
0
60.5
7.4
25.8
39.5
92.6
74.2 Suy hô hấp Không SHH
Nhóm 1 Nhóm 2 Tổng
1st Group 2nd Group Total
Comments: : 1st group 60.5% was higher than 2nd group 7.4%, the
difference was statictically significant, with p < 0.001.

24. TIME IN RECOVERY ROOM OF 02
GROUPS.
1st Group 2nd Group
Comments: : 1st group 30.94 ± 34.81 was longer than 2nd group 9.77 ±
9.38, the difference was statictically significant, with p < 0.001.

25. CCOONNCCLLUUSSIIOONN
MG patients have the same status, general
anesthesia, surgical time, using the same
anesthetic and analgesic drugs during and
post-op ® the patients, who use NMBDs
were the time of post-op spontaneous
ventilation via endotrachea, of mechanism
ventilation, of staying recovery room longer
and ratio of post-op mechanism ventilation,
respiratory faillure higher than the ones no
use NMBDs.