Onset and duration of mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy |
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Authors: | Schmidt J Muenster T Wick S Forst J Schmitt H J |
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Institution: | 1 Department of Anaesthesiology and 2 Department of Orthopaedics, Friedrich-Alexander University, Erlangen-Nuremberg, Erlangen, Germany |
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Abstract: | Background. To determine the response to mivacurium, we prospectivelystudied onset time and complete spontaneous recovery from mivacurium-inducedneuromuscular block in patients with Duchenne muscular dystrophy(DMD). Methods. Twelve boys with DMD, age 514 yr, seven of themwheelchair-bound, ASA IIIII, and 12 age- and sex-matchedcontrols (ASA I) were enrolled in the study. Anaesthesia wasinduced with fentanyl 23 µg kg1 and propofol34 mg kg1 titrated to effect, and maintained bycontinuous i.v. infusion of propofol 812 mg kg1and remifentanil as required. The lungs were ventilated withoxygen in air. Neuromuscular transmission was assessed by acceleromyographyusing train-of-four (TOF) stimulation every 15 s. After baselinereadings, a single dose of mivacurium 0.2 mg kg1 wasgiven. The following variables were recorded: (i) lag time;(ii) onset time; (iii) peak effect; (iv) recovery of first twitchfrom the TOF response to 10, 25 and 90% (T10, T25, T90) relativeto baseline; (v) recovery index (time between 25 and 75% recoveryof first twitch); and (vi) recovery time (time between 25% recoveryof first twitch and recovery of TOF ratio to 90%). For comparisonbetween the groups the MannWhitney U-test was applied. Results. There were no differences between the groups in lagtime, onset time and peak effect. However, all recorded recoveryindices were significantly (P<0.05) prolonged in the DMDgroup. The median (range) for time points T10, T25 and T90 inthe DMD and control group was 12.0 (816) vs 8.4 (515)min, 14.1 (920) vs 10.5 (717) min and 26.9 (1540)vs 15.9 (1223) min, respectively. The recovery indexand recovery time were similarly prolonged in the DMD group. Conclusions. These results support the assumption that mivacurium-inducedneuromuscular block is prolonged in patients with DMD.
This study was presented at the Annual Meeting of the AmericanSociety of Anaesthesiologists, Las Vegas, October 2004.
These authors contributed equally to this work. |
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Keywords: | complications neuromuscular disease monitoring neuromuscular function neuromuscular block mivacurium neuromuscular transmission |
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