Mivacurium chloride and myasthenia gravis.
We describe the successful use of the short-acting, non-depolarizing neuromuscular blocking agent, mivacurium, in a patient with myasthenia gravis taking pyridostigmine 120 mg four times daily. Increased sensitivity to mivacurium was demonstrated using train-of-four monitoring. A dose of 0.5 times the recommended ED95 (3.0 mg) resulted in 93% block of T1. Spontaneous recovery was prolonged with a recovery index (25%-75% T1) of 20.5 min. Residual block was antagonized without difficulty using neostigmine 2.5 mg. We discuss the relationship between plasma cholinesterase, acetylcholinesterase and anticholinesterase drugs.
Seigne
R D
RD
Department of Anaesthetics, Salisbury District Hospital, Wiltshire.
Scott
R P
RP
D000368:Aged; D000768:Anesthesia, General; D004576:Electromyography; D005260:Female; D006801:Humans; D007546:Isoquinolines; D000077590:Mivacurium; D009157:Myasthenia Gravis / Q000150:complications* / Q000188:drug therapy; D009407:Nerve Block; D009469:Neuromuscular Junction / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents; D011729:Pyridostigmine Bromide / Q000627:therapeutic use
D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D011729:Pyridostigmine Bromide