Technique of Thymectomy for Myasthenia Gravis

Preoperative Care  1. Regulation of basic requirement of neostigmine methyl sulfate (Prostigmin) must be exact, determined by hospital observation or long-term ambulatory control by the neurologist.2. In the female, the date for surgery is chosen so as not to coincide with the expected menses.3. Enemas are contraindicated in myasthenia gravis.4. Preliminary medication consists of a sedative, such as pentobarbital (nembutal), plus atropine sulfate. Use of narcotics is not wise.5. A continuous intravenous infusion of neostigmine methyl sulfate must be begun about one hour before anesthesia. The dose is calculated empirically as one-thirtieth of the daily oral dose, in milligrams.6. Whole blood should be available. It is administered through a second, separate infusion to avoid interference with continuity of the neostigmine drip.

Operative Management  1. The principles which permit the successful completion of thymectomy in myasthenia gravis include (a) coordinated teamwork of neurologist, anesthetist, and surgeon;