Onset and duration of rocuronium-induced neuromuscular blockade in patients with Duchenne muscular dystrophy.
BACKGROUND
In patients with Duchenne muscular dystrophy (DMD) the response to nondepolarizing muscle relaxants is scarcely documented and conflicting. The current study was conducted to determine the time to peak effect and the time for complete spontaneous recovery after a single dose of 0.6 mg/kg of rocuronium in patients with DMD.


METHODS
Twenty-four patients (12 with DMD, 12 controls, aged 10-16 yr) were studied. All patients were anesthetized with propofol and fentanyl/remifentanil. Neuromuscular transmission was monitored by acceleromyography. After induction all patients received a single dose of 0.6 mg/kg of rocuronium. The complete time course of onset and spontaneous recovery were recorded


RESULTS
Significant (P < 0.01) increase in the onset times to 95% neuromuscular block was observed in DMD patients (median, 203 s; range, 90-420 s) compared with controls (median, 90 s; range, 60-195 s). The time between rocuronium administration and recovery of first twitch of the train-of-four to 90% was significantly (P < 0.01) prolonged in DMD compared with controls (median, 132 min; range, 61-209 min versus 39 min; 22-55 min). The recovery index was also significantly prolonged in the DMD group compared with controls (median, 28 min, range, 15-70 min versus 8 min; 3-14 min).


CONCLUSIONS
The most striking and surprising result of this study is the delayed onset of blockade in DMD after a standard dose of rocuronium. This effect should be kept in mind in situations when a rapid airway protection is necessary in DMD patients. The documented very long recovery from rocuronium-induced block emphasizes the need for careful assessment of neuromuscular function in DMD patients.
Wick
Stefanie
S
Department of Anesthesiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Muenster
Tino
T
Schmidt
Joachim
J
Forst
Juergen
J
Schmitt
Hubert J
HJ
D000293:Adolescent; D000732:Androstanols; D000762:Anesthesia Recovery Period; D002648:Child; D004558:Electric Stimulation; D006801:Humans; D007700:Kinetics; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000503:physiopathology*; D009213:Myography; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents; D011229:Preanesthetic Medication; D000077123:Rocuronium; D009435:Synaptic Transmission; D014459:Ulnar Nerve / Q000502:physiology
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium