{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T22:53:09Z","timestamp":1766011989979,"version":"3.40.4"},"reference-count":9,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2013,3,7]],"date-time":"2013-03-07T00:00:00Z","timestamp":1362614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl\/remifentanyl and maintenance was obtained with sevoflurane\/desflurane\/propofol \u00b1 remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart\u00ae Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4\u00b10.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.<\/jats:p>","DOI":"10.4081\/pr.2013.e4","type":"journal-article","created":{"date-parts":[[2013,3,7]],"date-time":"2013-03-07T14:42:39Z","timestamp":1362667359000},"page":"e4","source":"Crossref","is-referenced-by-count":2,"title":["Video-Assisted Thoracoscopic Extended Thymectomy in Myasthenic Children"],"prefix":"10.3390","volume":"5","author":[{"given":"Rita","family":"Sonzogni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Novellino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Benigni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Busi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magda","family":"Khotcholava","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Spotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valter","family":"Sonzogni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2013,3,7]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/S1052-3359(25)00573-3","article-title":"Anesthesia and critical care of thymectomy or myathenia gravis","volume":"11","author":"Baraka","year":"2001","journal-title":"Chest Surg Clin N Am"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s00383-010-2838-4","article-title":"Preliminary results of VATS thymectomy for pediatric myasthenia gravis","volume":"27","author":"Parich","year":"2011","journal-title":"Pediatr Surg Int"},{"key":"ref3","first-page":"140","article-title":"Left thoracoscopic thymectomy in children Surg Endosc","volume":"19","author":"Seguier-Lipszyc","year":"2005"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1055\/s-2004-829587","article-title":"Anesthesia issues in the perioperative management of MG","volume":"24","author":"Dillon","year":"2004","journal-title":"Semin Neurol"},{"key":"ref5","first-page":"359","article-title":"Perioperative evaluation of myasthenia gravis","volume":"78","author":"Cardone","year":"2007","journal-title":"Ann Ital Chir"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1111\/j.1365-2044.2009.06236.x","article-title":"The use of sugammadex in a patient with myasthenia gravis","volume":"65","author":"Unterbuchner","year":"2010","journal-title":"Anesthesia"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/j.1460-9592.2004.01292.x","article-title":"Anesthesia for thymectomy in children with myasthenia gravis","volume":"14","author":"White","year":"2004","journal-title":"Pediatr Anesth"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.jpedsurg.2005.10.006","article-title":"Long-term follow-up after thymectomy for myasthenia gravis: thoracoscopic vs open","volume":"41","author":"Wagner","year":"2006","journal-title":"J Pediatr Surg"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/j.1399-6576.2008.01853.x","article-title":"The use of Desflurane or propofol in combination with remifentanyl in myasthenic patients undergoing a VATET","volume":"53","author":"Gritti","year":"2009","journal-title":"Acta Anesthesiol Scand"}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.pagepress.org\/journals\/index.php\/pr\/article\/viewFile\/4599\/3896","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.pagepress.org\/journals\/index.php\/pr\/article\/viewFile\/4599\/5589","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.mdpi.com\/2036-7503\/5\/1\/e4\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T23:29:28Z","timestamp":1745969368000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/5\/1\/e4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,7]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2013,2]]}},"alternative-id":["pr.2013.e4"],"URL":"https:\/\/doi.org\/10.4081\/pr.2013.e4","relation":{},"ISSN":["2036-7503"],"issn-type":[{"type":"electronic","value":"2036-7503"}],"subject":[],"published":{"date-parts":[[2013,3,7]]}}}