Clinical use of atracurium in myasthenia gravis: a case report

A patient with myasthenia gravis was anaesthetized for thymectomy utilizing atracurium for maintenance of muscle relaxation. The patient was not taking anticholinesterase medications before surgery. Neuromuscular function was monitored by recording the train-of-four response to supramaximal stimulation of the ulnar nerve. Anaesthesia was induced with thiopentone and maintained with isoflurane and N2O in oxygen. Following complete recovery from a succinylcholine block for intubation, the patient developed complete neuromuscular block within two minutes after atracurium (5 mg) was administered. Evidence of recovery commenced 12 minutes later and was complete at 72 minutes. This rate of recovery is consistent with the recovery rate from atracurium during isoflurane anaesthesia in normal patients. Atracurium appears to offer an advantage over other nondepolarizing muscle relaxants in patients with myasthenia gravis due to its shorter duration and less cumulative effect at the neuromuscular junction.