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BJA Advance Access published online on September 23, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei249
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted July 8, 2005

Clinical Investigation

Onset and duration of mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy{dagger}

J. Schmidt 1 {ddagger}, T. Muenster 1 {ddagger}, S. Wick 1, J. Forst 2, and H. J. Schmitt 1*

1 Department of Anaesthesiology, Friedrich-Alexander University, Erlangen-Nuremberg, Erlangen, Germany
2 Department of Orthopaedics, Friedrich-Alexander University, Erlangen-Nuremberg, Erlangen, Germany

* To whom correspondence should be addressed.
H. J. Schmitt, E-mail: hubert.schmitt{at}kfa.imed.uni-erlangen.de


  Abstract

Background. To determine the response to mivacurium, we prospectively studied onset time and complete spontaneous recovery from mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy (DMD).

Methods. Twelve boys with DMD, age 5-14 yr, seven of them wheelchair-bound, ASA II-III, and 12 age- and sex-matched controls (ASA I) were enrolled in the study. Anaesthesia was induced with fentanyl 2-3 µg kg-1 and propofol 3-4 mg kg-1 titrated to effect, and maintained by continuous i.v. infusion of propofol 8-12 mg kg-1 and remifentanil as required. The lungs were ventilated with oxygen in air. Neuromuscular transmission was assessed by acceleromyography using train-of-four (TOF) stimulation every 15 s. After baseline readings, a single dose of mivacurium 0.2 mg kg-1 was given. The following variables were recorded: (i) lag time; (ii) onset time; (iii) peak effect; (iv) recovery of first twitch from the TOF response to 10, 25 and 90% (T10, T25, T90) relative to baseline; (v) recovery index (time between 25 and 75% recovery of first twitch); and (vi) recovery time (time between 25% recovery of first twitch and recovery of TOF ratio to 90%). For comparison between the groups the Mann-Whitney U-test was applied.

Results. There were no differences between the groups in lag time, onset time and peak effect. However, all recorded recovery indices were significantly (P<0.05) prolonged in the DMD group. The median (range) for time points T10, T25 and T90 in the DMD and control group was 12.0 (8-16) vs 8.4 (5-15) min, 14.1 (9-20) vs 10.5 (7-17) min and 26.9 (15-40) vs 15.9 (12-23) min, respectively. The recovery index and recovery time were similarly prolonged in the DMD group.

Conclusions. These results support the assumption that mivacurium-induced neuromuscular block is prolonged in patients with DMD.

Keywords: complications, neuromuscular disease; monitoring, neuromuscular function; neuromuscular block, mivacurium; neuromuscular transmission.

{dagger}This study was presented at the Annual Meeting of the American Society of Anaesthesiologists, Las Vegas, October 2004.

{ddagger}These authors contributed equally to this work.


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