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- Title
Neuromuscular monitoring in myasthenic syndrome.
- Authors
Itoh, H.; Shibata, K.; Nitta, S.
- Abstract
We describe the anaesthetic management of a 72-year-old man with myasthenic syndrome. Pre-operatively, he was treated with 3,4-diaminopyridine and showed a strong hand grip. During general anaesthesia with nitrous oxide and sevoflurane in oxygen, a mechanomyograph and two accelerographs were set up for the hands and left foot to monitor neuromuscular function. Insufficient force and acceleration of contraction with 1 Hz stimulation was observed in the hands. In the foot, the twitches produced by 1 Hz and train-of-four stimulation could barely be detected using the accelerograph, and the train-of-four ratio fluctuated between 70 and 100%. No neuromuscular blocking drugs were used during surgery. After discontinuation of sevoflurane, responses to train-of-four stimulation remained small, but a strong response to tetanic stimulation was observed, with post-tetanic facilitation. Extubation was successful, and recovery from anaesthesia was uneventful. Tetanic stimulation and post-tetanic facilitation are important in monitoring neuromuscular function in patients with myasthenic syndrome whose train-of-four responses are insufficient.
- Subjects
ANESTHESIA; MYASTHENIA gravis
- Publication
Anaesthesia, 2001, Vol 56, Issue 6, p562
- ISSN
0003-2409
- Publication type
Article
- DOI
10.1046/j.1365-2044.2001.01968.x