Intravenous anesthesia

Abstract

Anesthesia and Pain Medicine. 2003 Dec. 7(4): 150-154
ⓒ Korean Society for Intravenous Anesthesia
  
 
 
Effects of Rocuronium in Myasthenia Gravis Undergoing Thymectomy
Yu Jeong Lim, M.D., Yoon Kyung Lee, M.D., Ji Yeun Sim, M.D., Dong Kwan Kim, M.D.*, Seong Il Park, M.D.*, and Hong Seuk Yang, M.D.
Departments of Anesthesiology, and *Thoracic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
 

BACKGROUND: Myasthenia gravis is an autoimmune disease caused by antibodies to the acetylcholine receptors at the neuromuscular junction. Loss of these receptors leads to a defect in neuromuscular transmission with muscle weakness and fatigue. Rocuronium is a monoquaternary steroid analogue of vecuronium and provides a rapid onset of action. The onset and duration of rocuronium in patients undergoing thymectomy due to myasthenia gravis was investigated.
METHODS: Eighteen patients undergoing thymectomy due to myasthenia gravis were allocated in myasthenia group. Eighteen patients of ASA physical status class 1, 2 without hepatic, renal or neuromuscular disease undergoing orthopedic surgery were allocated in control group. Anesthesia was induced with thiopental 4(-5) mg/kg and maintained with isoflurane (1.0(-1.2) vol%) and 50% N2O. Rocuronium 0.5 mg/kg in myasthenia gravis group and 0.6 mg/kg in control group was given. Trachea was intubated after the twitch response was depressed more than 95%. Neuromuscular relaxation was assessed by TOF with supramaximal stimulation of the ulnar nerve at 2 Hz every 12 sec. The onset time for T1, T2, T3, and T4 to appear from maximal blockade was recorded. And the recovery time from T1 to T4 was measured.
RESULTS: The onset time to maximal block was shortened and the time for T1 - T4 to appear from maximal blockade was prolonged in patients with myasthenia gravis. The recovery time from T1 to T4 was prolonged in patients with myasthenia gravis.
CONCLUSIONS: Rocuronium induced neuromuscular blockade more rapidly and recovered more slowly in patients with myasthenia gravis.
 
Key words : Myasthenia gravis, rocuronium
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