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Postoperative ventilatory dependency following thymectomy for myasthenia gravis.

Thymectomy for the treatment of selected patients with myasthenia gravis results in postoperative prolongation of ventilatory support. A retrospective review of 24 patients undergoing the procedure via midline sternotomy revealed that 17 (71%) were weaned from mechanical ventilation within 48 hours. In the remaining patients, chest wall pain and respiratory muscle weakness prolonged ventilatory support to four days while complications of pneumonia in 2 patients and hydropneumothorax in another patient prolonged support beyond four days. Additional observations suggested that choline-esterase inhibitor therapy is necessary to assist in weaning from mechanical ventilation even if this therapy is reduced from preoperative dosages.