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British Journal of Anaesthesia, 2001, Vol. 87, No. 6 885-889
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Difference in sensitivity to vecuronium between patients with ocular and generalized myasthenia gravis

H. Itoh1, K. Shibata2 and S. Nitta3

1Department of Anesthesiology and Intensive Care Medicine, Kanazawa University School of Medicine, Kanazawa, Japan. 2Department of Emergency and Critical Care Medicine, Kanazawa University School of Medicine, Kanazawa, Japan. 3Division of Anesthesia, Ishikawa Prefectural Central Hospital, Kanazawa, Japan*Corresponding author: Department of Anesthesiology and Intensive Care Medicine, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan

Patients with myasthenia gravis show sensitivity to non-depolarizing neuromuscular blocking drugs, but little is known about differences in this sensitivity between types of myasthenia. In 10 patients with ocular myasthenia gravis and 10 with generalized myasthenia gravis, twitch tension was monitored in the adductor pollicis muscle by supramaximal train-of-four stimulation of the ulnar nerve during anaesthesia with sevoflurane 2.5% and nitrous oxide 60%. After baseline measurement, an initial dose of vecuronium 10 µg kg–1 was given. When the twitch height stabilized (maximum block after the first 10 µg kg–1), the next incremental dose of 10 µg kg–1 was given and repeated until block, defined as [1–(first twitch/baseline first twitch)]x100 reached 90%. Maximum block after the first dose of vecuronium in ocular patients was significantly less than that in generalized patients (median 51 vs 91%; P<0.05). Onset of block after the first dose of vecuronium was significantly slower in ocular than in generalized myasthenic patients (mean 300 vs 200 s; P<0.05). Doses required to attain a block of 90% or more were significantly higher in ocular than in generalized patients (median 20 vs 10 µg kg–1; P<0.05). Clinicians should consider the type of disease according to the Osserman classification when using non-depolarizing neuromuscular blocking drugs in patients with myasthenia gravis.

Br J Anaesth 2001; 87: 885–9


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