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Canadian Journal of Anesthesia, Vol 46, 779-782, Copyright © 1999 by Canadian Anesthesiologists' Society

ARTICLES

Cisatracurium in a myasthenic patient undergoing thymectomy

A Baraka, S Siddik and N Kawkabani
Department of Anesthesiology, American University of Beirut, Lebanon. abaraka@aub.edu.lb

PURPOSE: The report investigates cisatracurium neuromuscular block in a myasthenic patient undergoing thymectomy. CLINICAL FEATURES: A myasthenic patient (Osserman II B) was prepared preoperatively with 240 mg x day(-1) pyridostigmine. The neuromuscular block produced by 0.05 mg x kg(-1) cisatracurium was monitored by Datex electromyography. The electromyographic response was compared with that in a control group of five non-myasthenic patients. In the myasthenic patient, cisatracurium resulted in a rapid onset of complete (97-98%) neuromuscular block, while a slow onset of partial (80-90%) block was achieved in the control group. Also, administration of 0.05 mg x kg(-1) neostigmine at the end of surgery reversed the neuromuscular block of cisatracurium in the non-myasthenic patients, but did not change the rate of spontaneous recovery in the myasthenic patient. CONCLUSION: The myasthenic patient is sensitive to cisatracurium, as evidenced by a more rapid onset and more marked neuromuscular block compared with the control non-myasthenic patients. This may be attributed to the decreased number of functional endplate acetylcholine receptors in the myasthenic patient, with a consequent decrease of the safety margin of neuromuscular transmission. Also, in contrast with the control group, the rate of recovery from neuromuscular block in the myasthenic patient was not enhanced by neostigmine at the end of surgery. This may be attributed to the prior inhibition of acetylcholinesterase by the preoperative pyridostigmine, as well as by possible desensitization of the cholinergic receptors secondary to prolonged pyridostigmine therapy.


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 Canadian J. AnesthesiaHome page
C. Chevalley, A. Spiliopoulos, M. de Perrot, J.-M. Tschopp, and M. Licker
Perioperative medical management and outcome following thymectomy for myasthenia gravis
Can J Anesth, May 1, 2001; 48(5): 446 - 451.
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 Canadian J. AnesthesiaHome page
A. S. Baraka, S. K. Taha, and N. I. Kawkabani
Neuromuscular interaction of sevoflurane - cisatracurium in a myasthenic patient
Can J Anesth, June 1, 2000; 47(6): 562 - 565.
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Copyright © 1999 by the Canadian Anesthesiologists' Society.