{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:30:47Z","timestamp":1784309447669,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2011,10,19]],"date-time":"2011-10-19T00:00:00Z","timestamp":1318982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2012,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Video\u2010assisted thoracoscopic extended thymectomy (<jats:styled-content style=\"fixed-case\">VATET<\/jats:styled-content>) is well established in the treatment of myasthenia gravis; however, patient selection remains controversial. Perioperative management protocol is lacking, and concerns regarding post\u2010operative myasthenic crisis still remain. We performed a retrospective observational study evaluating the impact of the introduction of a protocol in the perioperative management of patients with myasthenia gravis who underwent <jats:styled-content style=\"fixed-case\">VATET<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The perioperative management protocol was developed by a team of neurologists and anesthesiologists who reviewed the literature and their previous experience on myasthenia gravis patients. Respiratory, clinical, and neurological patient features were included in the protocol evaluation. A retrospective review of patients who underwent <jats:styled-content style=\"fixed-case\">VATET<\/jats:styled-content> before and after introduction to the protocol was finally performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The medical records of 66 patients (pre\u2010protocol group) and 44 patients (protocol group) were available for the study. In the pre\u2010protocol group, 17 patients (26%) were admitted to intensive care unit (<jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content>) during the post\u2010operative period, while three patients (6.8%) of the protocol group met the criteria for <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content> post\u2010operative admission. This resulted in a reduction of 73.5% of patients admitted to <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\"><jats:italic>P<\/jats:italic><\/jats:styled-content>\u2009=\u20090.023) and in an 80% (<jats:styled-content style=\"fixed-case\"><jats:italic>P<\/jats:italic><\/jats:styled-content>\u2009=\u20090.002) reduction of the use neuromuscular blocking agents. Two post\u2010operative myasthenic crises preceded by bulbar symptoms (1.8%) were identified in the pre\u2010protocol group patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although the application of our protocol results in a substantial reduction in the recovery of patients in the <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content> and in hospital costs, there was no substantial difference in mortality and morbidity between patients admitted to the surgical ward or to <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1399-6576.2011.02564.x","type":"journal-article","created":{"date-parts":[[2011,10,19]],"date-time":"2011-10-19T11:36:22Z","timestamp":1319024182000},"page":"66-75","source":"Crossref","is-referenced-by-count":28,"title":["A standardized protocol for the perioperative management of myasthenia gravis patients. Experience with 110 patients"],"prefix":"10.1111","volume":"56","author":[{"given":"P.","family":"GRITTI","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care Ospedali Riuniti di Bergamo  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"SGARZI","sequence":"additional","affiliation":[{"name":"Department of Neurology Ospedali Riuniti di Bergamo  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"CARRARA","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Ospedali Riuniti di Bergamo  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. A.","family":"LANTERNA","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Ospedali Riuniti di Bergamo  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"NOVELLINO","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Surgical Clinic A.O. Bolognini  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"SPINELLI","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Surgical Clinic A.O. Bolognini  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"KHOTCHOLAVA","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Ospedali Riuniti di Bergamo  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"POLI","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Ospedali Riuniti di Bergamo  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. 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