Neuromuscular effects of isoflurane in patients with myasthenia gravis.
Seventeen myasthenia gravis and seven control patients were studied mechano (MMG)- and electromyographically (EMG) during isoflurane/oxygen/air anaesthesia. In myasthenic patients the mean train-of-four ratio and neuromuscular block (by MMG) during 1.9 MAC isoflurane anaesthesia were 55 +/- 9% and 46 +/- 12%, respectively. The correlation between simultaneous MMG and EMG measurements was excellent (r2 = 0.933, P less than 0.001). The occurrence of HLA-B8 together with acetylcholine receptor antibodies seems to predispose myasthenic patients to a neuromuscular depression produced by isoflurane. Our current and prior results show that isoflurane possesses approximately twice as strong a neuromuscular blocking effect as halothane in myasthenic patients.
Nilsson
E
E
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Muller
K
K
D000328:Adult; D000769:Anesthesia, Inhalation; D000906:Antibodies / Q000032:analysis; D003864:Depression, Chemical; D005260:Female; D015795:HLA-B8 Antigen / Q000032:analysis; D006801:Humans; D007530:Isoflurane / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000276:immunology / Q000503:physiopathology*; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000503:physiopathology; D011950:Receptors, Cholinergic / Q000276:immunology
D000906:Antibodies; D015795:HLA-B8 Antigen; D011950:Receptors, Cholinergic; D007530:Isoflurane