Thymus

Question 1

What are the two most common indications for

thymectomy?

Answer 1

Thymoma and myasthenia gravis
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 316.

Question 2

Where do T lymphocytes mature? Where do B

Lymphocytes mature?

Answer 2

In the thymus. B lymphocytes mature in the bone marrow.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1017

Question 3

What type of anesthetic is used for thymectomy?

Answer 3

General anesthesia. An epidural catheter may be used for
postoperative pain management if a transsternal approach is
used. The surgeon may request one-lung ventilation.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 318.

Question 4

What type of incision is made for thymectomy?

Answer 4

A thymectomy can be performed via a complete sternotomy, a
manubrial split (upper sternotomy), or via a cervical incision.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 316.

Question 5

What is the primary advantage of performing a

complete sternotomy for thymectomy?

Answer 5

A complete sternotomy allows for complete resection of the
thymus which can be difficult via a manubrial or cervical incision.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 316.

Question 6

Most of the anesthetic concerns for a patient
undergoing thymectomy pertain to what underlying
disease?

Answer 6

Most of the anesthetic concerns for thymectomy are related to
the presence of myasthenia gravis, which is the most common
reason for undergoing this procedure.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 318.

Question 7

If an incidental pneumothorax occurs during a

thymectomy, on what side is it most likely to occur?

Answer 7

The right side
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 319.

Question 8

What is the main advantage of a manubrial incision

over a complete sternotomy?

Answer 8

Besides being less invasive, a manubrial incision can allow
excision of the thymus gland without entering the pleura.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 316.

Question 9

Into what vein does the thymic vein drain?

Answer 9

It drains into the innominate vein.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 316.