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British Journal of Anaesthesia, 1988, Vol. 60, No. 2 228-231
© 1988 The Board of Management and Trustees of the British Journal of Anaesthesia

case-report

MUSCLE RELAXATION IN PATIENTS WITH DUCHENNE'S MUSCULAR DYSTROPHY

Use of Vecuronium in Two Patients

W. BUZELLO, M.D. and H. HUTTARSCH, M.D.

University Department of Anaesthesiology, Joseph-Stelzmann-Str 9, D-5000 Koeln 41, Federal Republic of Germany

Cumulative 50% and 90% neuromuscular blocking doses of vecuronium were determined in two 4-yr-old boys with Duchenne's muscular dystrophy. Vecuronium 20 µg kg–1 was required for 50% twitch depression in both patients. The 90% blocking doses were 43 and 57 µg kg–1. Although these data do not indicate a greater than normal sensitivity to vecuronium, the recovery time (75–25% block) of twitch tension was three to almost six times as long as in normal children. The evoked compound EMG, additionally recorded in one patient, reflected almost the same dose-response relationship as twitch tension, yet the EMG recovered faster than the twitch. The present findings do not exclude an increased sensitivity to neuromuscular blocking drugs in a larger population of patients with muscular dystrophy. Thus, the titration of the individual neuromuscular blocking dose with the aid of a nerve stimulator is mandatory. During a previous anaesthetic, cardiac arrest and acute rhabdomyolysis had occurred in one patient. The substitution of suxamethonium by vecuronium, or probably any other non-depolarizing myoneural blocking drug of intermediate or short duration of action, may help to avoid this complication.


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