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Canadian Journal of Anesthesia, Vol 32, 642-645, Copyright © 1985 by Canadian Anesthesiologists' Society

Clinical Use of Atracurium in Myasthenia Gravis: A Case Report

FREDERIC M. RAMSEY MD1 and GARY D. SMITH MD1

1 Department of Anesthesia at The Wake Forest University Medical Center, The Bowman Gray School of Medicine, 300 South Hawthorne Road, Winston- Salem, NC 27103

correspondence should be addressed to Dr. Ramsey

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.

Key Words: NEUROMUSCULAR RELAXANTS: atracurium • MYASTHENIA GRAVIS






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Copyright © 1985 by the Canadian Anesthesiologists' Society.