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Sensitivity to vecuronium in myasthenia gravis: a dose-response study
J B Eisenkraft1, W J Book, A E Papatestas
1Department of Anesthesiology, Mount Sinai School of Medicine, City University of New York, NY 10029-6574.
Summary
Patients with myasthenia gravis require significantly less vecuronium than normal patients. This study determined the precise potency of vecuronium in myasthenic and normal individuals.
Area of Science:
- Anesthesiology
- Pharmacology
- Neuromuscular Disorders
Background:
- Neuromuscular blocking agents are crucial in anesthesia.
- Vecuronium is a commonly used non-depolarizing neuromuscular blocker.
- Myasthenia gravis is an autoimmune disorder affecting neuromuscular transmission.
Purpose of the Study:
- To determine and compare the potency of vecuronium in normal patients and patients with myasthenia gravis.
- To assess the influence of preoperative pyridostigmine and corticosteroid treatment on vecuronium sensitivity in myasthenic patients.
Main Methods:
- Utilized a cumulative dose plus infusion technique.
- Monitored neuromuscular blockade using integrated electromyography (EMG) of the first dorsal interosseous muscle.
- Administered thiamylal, N2O, O2, and fentanyl anesthesia.
Main Results:
- Myasthenic patients exhibited increased sensitivity to vecuronium, requiring approximately 50-56% of the dose compared to normal patients.
- The effective dose for 50% (ED50), 90% (ED90), and 95% (ED95) inhibition were significantly lower in myasthenic individuals.
- No significant difference in vecuronium sensitivity was observed based on preoperative pyridostigmine or chronic corticosteroid use in myasthenic patients.
Conclusions:
- Myasthenia gravis significantly enhances sensitivity to vecuronium.
- The findings provide crucial data for optimizing vecuronium dosage in myasthenic patients undergoing anesthesia.
- Preoperative treatments like pyridostigmine and corticosteroids did not alter vecuronium sensitivity in this study population.