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British Journal of Anaesthesia, Vol 82, Issue 5 774-776, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

CASE REPORTS

Bladder exstrophy in a neonate at risk of transient myasthenia gravis: a role for remifentanil and epidural analgesia

L. Wee and M. A. Stokes
Department of Anaesthesia, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK

Infants born to mothers with myasthenia gravis may exhibit a transient form of the disease, with similar sensitivity to non-depolarizing neuromuscular blocking drugs. We report the case of an infant at risk who required major surgery when 48 h old for closure of bladder exstrophy. A combined epidural-general anaesthetic technique, with remifentanil supplementation, enabled us to avoid unnecessary neuromuscular blocking drugs and prolonged intensive care, which had been anticipated. The potential benefits of remifentanil and epidural analgesia in neonates are discussed.
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