The requirement for post-op mechanical ventilation in myasthenia gravis patients is based on multiple factors including perioperative risk factors as well as pre-operative health. The following are factors described to be indicative of higher likelihood for post-op mechanical ventilation requirements following a thymectomy (1):
- Duration of myasthenia gravis (>6 years)
- Concomitant chronic lung disease
- Large doses of pyridostigmine maintenance (>750mg/day)
- Low vital capacity on PFTs (<2.9L)
More recently, additional factors have been thought to also increase chances of post-op mechanical ventilation, including (2):
- Positivity for anti-acetylcholine antibodies
- Low vital capacity (<2.9 L)
- CT scan imaging showing a thymoma
- Pre-op history of a prior myasthenic crisis
Interestingly, this study did not show any statistically significant effect of duration of myasthenia gravis or pre-op pyridostigmine dosage with regards to post-op ventilation requirements.
References
- S.R. Leventhal, F.K. Orkin, R.A. Hirsh. Prediction of the need for postoperative mechanical ventilation in myasthenia gravis. Anesthesiology, 53 (1980), pp. 26-30 PubMed Link
- Chigurupati, Keerthi, et al. “Criteria for Postoperative Mechanical Ventilation After Thymectomy in Patients With Myasthenia Gravis: A Retrospective Analysis.” Journal of Cardiothoracic and Vascular Anesthesia, vol. 32, no. 1, Feb. 2018, pp. 325–330. PubMed Link
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