Propofol-based total intravenous anesthesia versus inhalational anesthesia for thymectomy in patients with myasthenia gravis: A scoping review

Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction. Thymectomy is an important treatment option, but anesthetic management remains controversial due to unpredictable responses to neuromuscular blocking agents and the risk of postoperative respiratory failure. We conducted a scoping review following PRISMA-ScR guidelines to map the available evidence comparing propofol-based total intravenous anesthesia (TIVA) with inhalational anesthesia for thymectomy in patients with MG. A systematic search of PubMed, Scopus, Cochrane CENTRAL, and Google Scholar was performed. Studies comparing propofol TIVA with inhalational anesthesia in adult MG patients undergoing thymectomy were included. Data on study characteristics, anesthetic technique, perioperative outcomes, and complications were extracted. Nine comparative studies (586 patients) were included. Neuromuscular transmission was significantly more depressed with sevoflurane, but recovered completely by the end of surgery. Postoperative pulmonary complications (pneumonia or prolonged ventilation) were rare and occurred almost exclusively in the inhalational anesthesia group. Recovery times were generally shorter with inhalational anesthesia, though the difference was not always statistically significant. Propofol TIVA was associated with better early postoperative analgesia in one study. Multiple sources of bias were identified, including discrepancies between text and figures, overlapping cohorts, and implausible data reporting. The evidence base comparing propofol TIVA and inhalational anesthesia for thymectomy in MG is limited and heterogeneous. While both techniques appear safe, postoperative pulmonary complications were predominantly associated with inhalational anesthesia. The deeper neuromuscular depression with sevoflurane did not translate into improved surgical conditions or better outcomes. Further prospective, randomized studies are required to establish definitive recommendations.