Mivacurium in multicore disease.
Overall, the time course of recovery and the finding of faster recovery of corrugator supercilii muscles in response to a standard dosage of mivacurium in our patient are within the range of published data from patients without myopathies (3). Remarkably, however, is the extent of difference in the recovery time between adductor pollicis and corrugator supercilii muscles. Compared with corrugator supercilii muscles, the markedly prolonged recovery of the adductor pollicis muscles may indicate possible involvement of these muscles by myopathy, though this was not apparent clinically. In conclusion, the differential involvement of different muscles by multicore disease indicates that the choice of site for recording of neuromuscular transmission is an important issue. Due to the difference of recovery time between adductor pollicis and corrugator supercilii muscles, and the well-known fact that the corrugator supercilii muscles respond like the diaphragm to muscle relaxants (3), we recommend monitoring of neuromuscular transmission at corrugator supercilii muscles in patients with multicore disease.
(1.) Gordon CP, Litz S. Multicore myopathy in a patient with anhidrotic ectodermal dysplasia. Can J Anaesth 1992; 39: 966-968.
(2.) Viby-Mogensen J, Engbaek J, Eriksson LI, et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40:59-74.
(3.) Hemmerling TM, Schmidt J, Hanusa C, Wolf T, Schmitt H. Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles. Br J Anaesth 2000; 85:856-860.
H. J. SCHMITT
Department of Anaesthesiology,
TABLE 1 Time coarse of neuromuscular block after administration of mivacuriuna 0.2 mg.[kg.sup.-1] Site of Onset [T.- [T.- [T.- [T.sub.- [T.- Monitoring Time sub.10] sub.25] sub.90] 25-75] sub.25] (min) (min) (min) (min) (min) TO[F.- sub.90] (min) Adductor polficis 2.1 14.1 15.4 24.1 7.3 23.1 Corrugator superatii 2.4 7.7 10.2 22.2 7.5 15.4 [T.sub.10], [T.sub.25], [T.sub.90] = time of recovery of the first twitch. [T.sub.25-75] = time between 25% and 75% recovery of first twitch (recovery index). TOF = ratio fourth to first twitch out of train-of-four. [T.sub.25]-TO[F.sub.90] = time between 25% recovery of the first twitch and recovery of TOF ratio to 90% (complete recovery time).
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|Author:||Munster, T.; Schmitt, H.J.|
|Publication:||Anaesthesia and Intensive Care|
|Date:||Jun 1, 2006|
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