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British Journal of Anaesthesia, 1989, Vol. 63, No. 4 497-500
© 1989 The Board of Management and Trustees of the British Journal of Anaesthesia

case-report

SENSITIVITY TO BOTH VECURONIUM AND NEOSTIGMINE IN A SERO-NEGATIVE MYASTHENIC PATIENT

JONG-MIN KIM, M.D. and JOEL MANGOLD, M.D.

Department of Anesthesiology, University of Kansas, College of Health Sciences and Hospital Kansas City, Kansas 66103, U.S.A.

Correspondence to J.-M.K

We describe a sero-negative ocular myasthenic patient who showed exaggerated responses to both vecuronium and neostigmine. These hypersensitive responses were not anticipated because preoperative clinical and laboratory evaluations suggested a negligible impairment of somatic muscles by myasthenic processes. This case report re-emphasizes that, if neuromuscular blocking agents and their antagonists are administered to myasthenic patients, regardless of the degree of impairment, the dose should be titrated carefully with the aid of a neuromuscular transmission monitor.


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