author_facet Gamez, Josep
Salvadó, María
Carmona, Francesc
de Nadal, Miriam
Romero, Laura
Ruiz, Daniel
Jáuregui, Alberto
Martínez, Olga
Pérez, Javier
Suñé, Pilar
Deu, María
Gamez, Josep
Salvadó, María
Carmona, Francesc
de Nadal, Miriam
Romero, Laura
Ruiz, Daniel
Jáuregui, Alberto
Martínez, Olga
Pérez, Javier
Suñé, Pilar
Deu, María
author Gamez, Josep
Salvadó, María
Carmona, Francesc
de Nadal, Miriam
Romero, Laura
Ruiz, Daniel
Jáuregui, Alberto
Martínez, Olga
Pérez, Javier
Suñé, Pilar
Deu, María
spellingShingle Gamez, Josep
Salvadó, María
Carmona, Francesc
de Nadal, Miriam
Romero, Laura
Ruiz, Daniel
Jáuregui, Alberto
Martínez, Olga
Pérez, Javier
Suñé, Pilar
Deu, María
Therapeutic Advances in Neurological Disorders
Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
Neurology (clinical)
Neurology
Pharmacology
author_sort gamez, josep
spelling Gamez, Josep Salvadó, María Carmona, Francesc de Nadal, Miriam Romero, Laura Ruiz, Daniel Jáuregui, Alberto Martínez, Olga Pérez, Javier Suñé, Pilar Deu, María 1756-2864 1756-2864 SAGE Publications Neurology (clinical) Neurology Pharmacology http://dx.doi.org/10.1177/1756286419864497 <jats:sec><jats:title>Background:</jats:title><jats:p> Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m<jats:sup>2</jats:sup>, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia. </jats:p></jats:sec> Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis Therapeutic Advances in Neurological Disorders
doi_str_mv 10.1177/1756286419864497
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Chemie und Pharmazie
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series Therapeutic Advances in Neurological Disorders
source_id 49
title Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_unstemmed Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_full Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_fullStr Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_full_unstemmed Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_short Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_sort intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
topic Neurology (clinical)
Neurology
Pharmacology
url http://dx.doi.org/10.1177/1756286419864497
publishDate 2019
physical 175628641986449
description <jats:sec><jats:title>Background:</jats:title><jats:p> Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m<jats:sup>2</jats:sup>, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia. </jats:p></jats:sec>
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author Gamez, Josep, Salvadó, María, Carmona, Francesc, de Nadal, Miriam, Romero, Laura, Ruiz, Daniel, Jáuregui, Alberto, Martínez, Olga, Pérez, Javier, Suñé, Pilar, Deu, María
author_facet Gamez, Josep, Salvadó, María, Carmona, Francesc, de Nadal, Miriam, Romero, Laura, Ruiz, Daniel, Jáuregui, Alberto, Martínez, Olga, Pérez, Javier, Suñé, Pilar, Deu, María, Gamez, Josep, Salvadó, María, Carmona, Francesc, de Nadal, Miriam, Romero, Laura, Ruiz, Daniel, Jáuregui, Alberto, Martínez, Olga, Pérez, Javier, Suñé, Pilar, Deu, María
author_sort gamez, josep
container_start_page 0
container_title Therapeutic Advances in Neurological Disorders
container_volume 12
description <jats:sec><jats:title>Background:</jats:title><jats:p> Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m<jats:sup>2</jats:sup>, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia. </jats:p></jats:sec>
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spelling Gamez, Josep Salvadó, María Carmona, Francesc de Nadal, Miriam Romero, Laura Ruiz, Daniel Jáuregui, Alberto Martínez, Olga Pérez, Javier Suñé, Pilar Deu, María 1756-2864 1756-2864 SAGE Publications Neurology (clinical) Neurology Pharmacology http://dx.doi.org/10.1177/1756286419864497 <jats:sec><jats:title>Background:</jats:title><jats:p> Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m<jats:sup>2</jats:sup>, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia. </jats:p></jats:sec> Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis Therapeutic Advances in Neurological Disorders
spellingShingle Gamez, Josep, Salvadó, María, Carmona, Francesc, de Nadal, Miriam, Romero, Laura, Ruiz, Daniel, Jáuregui, Alberto, Martínez, Olga, Pérez, Javier, Suñé, Pilar, Deu, María, Therapeutic Advances in Neurological Disorders, Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis, Neurology (clinical), Neurology, Pharmacology
title Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_full Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_fullStr Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_full_unstemmed Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_short Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_sort intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
title_unstemmed Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis
topic Neurology (clinical), Neurology, Pharmacology
url http://dx.doi.org/10.1177/1756286419864497