title: Myasthenia gravis and pipecuronium--report of two cases.
abstract: The use of pipecuronium in two patients with myasthenia gravis undergoing thymectomy is described. Neuromuscular function was monitored throughout using the train-of-four (TOF) mechanical twitch response. The cumulative dose-response to pipecuronium was determined in both patients during nitrous oxide-oxygen-narcotic anaesthesia. Both patients were sensitive to pipecuronium. The ED50 doses of pipecuronium were 11.6 and 11.1 micrograms.kg-1 and the ED95 doses were 35 and 33.3 micrograms.kg-1 in patients #1 and 2 respectively. Edrophonium 1 mg.kg-1 and neostigmine 0.06 mg.kg-1 were administered to patients #1 and 2 respectively for antagonism of residual neuromuscular blockade at 25 per cent spontaneous recovery of first twitch (T1) of the TOF stimulation. As with other non-depolarizing muscle relaxants pipecuronium in reduced dosage and with careful neuromuscular monitoring can be used to provide surgical relaxation safely in patients with controlled myasthenia gravis.
authors.affiliation: Division of Anaesthesia, King Khalid University Hospital, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Naguib
authors.forename: A
authors.initials: A
authors.lastname: Sari-Kouzel
authors.forename: M
authors.initials: M
authors.lastname: Ashour
authors.forename: M
authors.initials: M
authors.lastname: Seraj
authors.forename: F
authors.initials: F
authors.lastname: Messahel
mesh_terms: D000328:Adult; D015113:Androstane-3,17-diol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D017300:Pipecuronium; D010879:Piperazines / Q000008:administration & dosage*; D013934:Thymectomy
chemical_list: D009466:Neuromuscular Blocking Agents; D010879:Piperazines; D017300:Pipecuronium; D015113:Androstane-3,17-diol