Nursing Care of General Anesthesia for Thymectomy in Patients with Myasthenia Gravis: Case Study

Abstract

      Thymectomy is one of the treatment methods for patients with Myasthenia gravis. The roles of anesthetist nurse in administering anesthesia to patients in this group are complex and crucial, beginning with preparing the patient physically and mentally, organizing and obtaining equipment, monitoring during anesthesia administration, and postoperative complications monitoring. Effective pain management is a crucial aspect that helps patients safely recover from their life-threatening conditions and avoid complications, allowing them to recover leading to their normal healthy status. This is a case study, the objective was to investigate the nursing outcomes of administering general anesthesia for thymectomy department of Cardio-Vascular-Thoracic surgery, Buriram Hospital Retrospective data were collected from the medical records of 1 patient Who undergone thymectomy in September 2022. The tools used to collect data include: 1) case recording form gather information from patient medical records, 2) health assessment records and 3) nursing planning records.

Results: Thai 37 years old female patient, was diagnosed generalized myasthenia gravis Stage

2B. Chief complaint was followed appointment for thymus surgery under general anesthesia. Anesthesia nursing care devided to 3 phases: before, during and after receiving anesthesia. In the period before anesthesia was administered, patients encounter the following problems: 1) anxiety due to lack of knowledge on how to do before and after anesthesia had given. 2) There was risk of acute muscle weakness due to stopping and changing immunosuppressive drugs to prepare before surgery. During anesthesia, problems were found: 1) risk of difficult ventilation and endotracheal intubation due to the patient's physiological abnormalities, 2) risk of acute bronchospasm due to muscles did not relaxed enough, 3) awareness because the body did not respond well to the muscle relaxation drugs and 4) hypothermia during surgery. After the anesthesia was given, problems were found: 1) risk of ineffective breathing after surgery, 2) risk of hypoventilation after removing the endotracheal tube, 3) discomfort for wound pain.

After nursing care, evaluation showed patients had knowledge and understood about how to do before and after surgery. Anxiety decreased, and status prompt to surgery both physically and mentally. There was no complication during the administration of anesthesia with stable vital sign. The post-operative period found that patient required re-intubation due to wound pain and dyspnea, that relief by effective pain management and multimodal analgesia. This allowed her to recover leading to patient extubation and no other complications, resulting in 10 days hospital stay.