[Neuromuscular blockade monitoring at the corrugator supercilii and ocular myasthenia gravis].
A 67-year-old patient suffering from an ocular myasthenia gravis was scheduled for an elective ENT surgery. General anaesthesia was induced intravenously. Neuromuscular responses after train-of-four stimulation were normal at both the adductor pollicis (T(4)/T(1) = 1) and the corrugator supercilii (4 visual responses). Then cisatracurium (0,15 mg kg(-1)) was administered to allow tracheal intubation. The laryngoscopy attempted 45 s after cisatracurium injection (no response at the supercilii, T(1)/T(0) = 1 at the adductor pollicis) was unsuccessful because of closing and moving vocal cords. The second attempt was successful 4 min after cisatracurium injection (no response at the corrugator supercilii, T(1)/T(0) = 0.05 at the adductor pollicis). Residual neuromuscular blockade was antagonized at the end of surgery (1 h long) allowing an uneventful extubation. We concluded that monitoring neuromuscular blockade at the corrugator supercilii to assess the intubating conditions is not recommended in a case of ocular myasthenia gravis.
Département d'anesthésiologie-réanimation-urgences, fondation Adolphe-de-Rothschild, 25-29, rue Manin, 75940 Paris cedex 19, France. jmdevys@fo-rothschild.fr
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JM
Devys
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V
Guellec
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A
Corré
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Plaud
D000368:Aged; D000768:Anesthesia, General; D001279:Atracurium; D004558:Electric Stimulation; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D016343:Monitoring, Intraoperative; D018482:Muscle, Skeletal; D009157:Myasthenia Gravis / Q000503:physiopathology*; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents; D015840:Oculomotor Nerve Diseases / Q000503:physiopathology*; D014827:Vocal Cords / Q000502:physiology
D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium