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ANESTHETIC PHARMACOLOGY

Sensitivity to Vecuronium in Seropositive and Seronegative Patients with Myasthenia Gravis

Hironori Itoh, MD^*, Keizo Shibata, MD, and Shunichi Nitta, MD

Departments of *Anesthesiology and Intensive Care Medicine and Emergency and Critical Care Medicine, Kanazawa University School of Medicine, Kanazawa, Japan; and Division of Anesthesia, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

Address correspondence and reprint requests to Hironori Itoh, MD, Department of Anesthesiology and Intensive Care Medicine, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan. Address e-mail to hironori{at}med.kanazawa-u.ac.jp

Patients with myasthenia gravis (MG) are hypersensitive to nondepolarizing neuromuscular blocking drugs. Although antibodies to the acetylcholine receptor (AChR) often are observed in MG patients, 10% to 30% of patients do not show an anti-AChR antibody. Little is known about differences in sensitivity to nondepolarizing neuromuscular blocking drugs between MG patients with and without anti-AChR antibody. Hypothesizing that seronegative patients are as sensitive to vecuronium as seropositive patients, we assessed sensitivity in seropositive and seronegative MG patients and in non-MG patients (n = 8 each). During anesthesia with sevoflurane (2.5%) and nitrous oxide (60%) in oxygen, neuromuscular transmission was monitored by measuring the twitch tension of the adductor pollicis muscle with supramaximal stimulation. After baseline measurements, 10 µg/kg IV dose increments of vecuronium were administered sequentially until blockade exceeded 90%. The degree of blockade and onset time after the initial 10 µg/kg of vecuronium were assessed, and doses required to exceed 90% blockade were recorded. In addition, effective doses of 50% and 95% for vecuronium were calculated from a single data point. Both types of MG patients showed increased sensitivity to vecuronium compared with non-MG patients.

IMPLICATIONS: Hypothesizing that seronegative patients are as sensitive to vecuronium as seropositive patients, we assessed sensitivity in seropositive and seronegative myasthenia gravis (MG) patients and in non-MG patients. They were, indeed, both equally sensitive to vecuronium.

This article has been cited by other articles:

				G. Basaranoglu, V. Erden, H. Delatioglu, and H. Itoh Anesthesia of a Patient with Cured Myasthenia Gravis * Response Anesth. Analg., June 1, 2003; 96(6): 1842 - 1843. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999