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Mivacurium-induced neuromuscular block in adult patients suffering from Charcot-Marie-Tooth disease

[Le blocage neuromusculaire induit par le mivacurium chez des patients adultes atteints de la maladie de Charcot-Marie-Tooth]

From the Department of Anesthesiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.

Address correspondence to: Dr. Hubert J. Schmitt, Department of Anesthesiology, Friedrich-Alexander Universität, Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany. Phone: 9131-85-33680; Fax: 9131-85-36147; E-mail: hubert.schmitt{at}kfa.imed.uni-erlangen.de

Purpose: The response to non-depolarizing neuromuscular blocking drugs is variable in patients with Charcot-Marie-Tooth (CMT) disease. We speculated that CMT involvement of the monitored muscle may be partially responsible for this inconsistency. We therefore investigated the response to a standard dose of mivacurium simultaneously assessed at adductor pollicis (AP) and orbicularis oculi (OO) muscles in five patients with CMT.

Clinical features: Over a period of one year, five adult patients with CMT scheduled for orthopedic surgery were studied. The right arm and the right supercilliary arch were prepared for acceleromyographic (AMG) neuromuscular monitoring. The AMG probes were attached at the distal interphalangeal joint of the right thumb and on the right upper eyelid to record the response of the AP and OO, respectively. The ulnar nerve and upper part of the facial nerve were stimulated supramaximally with repeated train-of-four stimuli (2 Hz, 0.2 msec) every 15 sec via applied surface electrodes. Following monitor calibration and induction of general anesthesia, mivacurium 0.2 mg·kg^{– 1} iv was given, and the time course of relaxation and recovery were assessed. Times to spontaneous recovery of T1 to 25% were 15 ± 3 vs 12 ± 4 min in the AP and OO muscle groups respectively, whereas times to 90% recovery were 23 ± 5 vs 29 ± 10 min, respectively.

Conclusion: The onset and recovery characteristics associated with mivacurium-induced neuromuscular block were similar at the AP and OO muscle groups. A near normal response to mivacurium was observed in this small series of patients with CMT disease.