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
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.
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.
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.
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.
Notes de l'éditeur
Định nghĩa Berlin về ARDS 6/2012: không còn ALI; loại áp lực ĐM phổi bít (PAWP).
Thời gian: trong vòng 1 tuần
XQ
Oxy hóa: (1) Nhẹ 200 &lt; P/F ≤ 300; (2) TB 100 &lt; P/F ≤ 200; (3) nặng P/F ≤ 100; tất cả PEEP ≥ 5
- Ngay cả thể tích khí lưu thông 6 ml/kg tốt hơn hoặc xấu hơn thể tích khí lưu thông 8 ml/kg vẫn còn là vấn đề đang bàn cãi. Tuy nhiên, cho đến khi có những bằng chứng chứng minh ngược lại, Vt 6 ml/kg nên được xem như tiêu chuẩn cho điều trị. Cần nhấn mạnh là các thử nghiệm của ARDS network, tính Vt dựa trên cân nặng lý tưởng, không phải cân nặng thực tế, và nếu tính trên cân nặng thực tế thì trung bình Vt là 5 ml/kg.