Canadian Journal of Anaesthesia

, Volume 37, Issue 3, pp 301–306 | Cite as

Sensitivity to vecuronium in myasthenia gravis: a dose-response study

  • James B. Eisenkraft
  • W. Jeffrey Book
  • Angelos E. Papatestas
Reports of Investigation

Abstract

A cumulative dose plus infusion technique and integrated EMG monitoring of the first dorsal interosseous muscle were used to determine the potency of vecuronium in 20 normal patients and in ten patients with myasthenia gravis under thiamylal, N2O, O2, fentanyl anaesthesia. The mean (± SEM) values for ED50, ED90, and ED95 in the normal patients were 19 ± 1, 31 ± 1 and 36 ± 2 μg · kg− 1, respectively. Myasthenic patients showed increased sensitivity to vecuronium, the mean values for ED50, ED90, and ED95 were 10 ± 2, 17 ± 2 and 20 ± 3 μg · kg− 1, being50, 55 and 56 per cent of normal, respectively. We did not demonstrate a difference in sensitivity to vecuronium between those myasthenic patients who received pyridostigmine preoperatively and those who did not, nor among those chronically treated with corticosteroids, compared with those who were not.

Key words

complications: myasthenia gravis neuromuscular relaxants: vecuronium measurement techniques: electromyography, neuromuscular blockade 

Résumé

Une dose cumulative plus une technique de perfusion et une surveillance électromographique intégrée du muscle interosseux dorsal fut utilisée afin de déterminer la puissance du vécuronium chez 20 patients normaux et chez dix patients atteints de myasthénie grave sous thiamylal, N2O, O2, et fentanyl. Les valeurs moyennes (± SEM) du ED50, ED90 et ED95 chez les patients normaux étaient de 19 ± 1, 31 ± 1 et 36 ± 2 gmg · kg− 1 respectivement. Les patients myasthéniques ont démontré une augmentation de la sensitivité au vécuronium, les valeurs movennes de la ED50, ED90 et ED95 furent 10 ± 2, 17 ± 2 et 20 ± 3 μg · kg− 1 étant respectivement 50, 55 et 56 pour cent de la normale. On n’a pas démontré de différence avec les patients avant reçu de la pyridostigmine en période préopératoire et ceux qui n’en n’ont pas reçue, de même qu’on n’en a pas trouvé avec ceux qui étaient traités aux corticostéroīdes comparé à ceux qui ne l’étaient pas.

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Copyright information

© Canadian Anesthesiologists 1990

Authors and Affiliations

  • James B. Eisenkraft
    • 1
  • W. Jeffrey Book
    • 1
  • Angelos E. Papatestas
    • 1
  1. 1.Department of SurgeryMount Sinai School of Medicine of the City University of New YorkNew York

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