A patient with myasthenia gravis showing lower sensitivity to rocuronium and earlier recovery of train-of-four responses on electromyography compared to acceleromyography: a case report

Background Although newly developed electromyographic devices have been introduced in anesthetic practice, reports on their use in patients with myasthenia gravis (MG) are lacking. We describe electromyographic monitoring combined with acceleromyography in a myasthenic patient. Case presentation A 5...

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Published inJA clinical reports Vol. 11; no. 1; pp. 39 - 6
Main Authors Murakami, Yoshiko, Fujimoto, Masafumi, Hirata, Naoyuki
Format Journal Article
LanguageEnglish
Published Berlin/Heidelberg Springer Berlin Heidelberg 07.07.2025
Springer Nature B.V
SpringerOpen
Subjects
Acceleromyography
Anesthesiology
Calibration
Case Report
Critical Care Medicine
Electromyography
Emergency Medicine
General anesthesia
Intensive
Medicine
Medicine & Public Health
Myasthenia gravis
Pain Medicine
Patients
Ratios
Robotic surgery
Japan
Electromyography
Acceleromyography
Myasthenia gravis
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Summary:Background Although newly developed electromyographic devices have been introduced in anesthetic practice, reports on their use in patients with myasthenia gravis (MG) are lacking. We describe electromyographic monitoring combined with acceleromyography in a myasthenic patient. Case presentation A 55-year-old female underwent robot-assisted thoracoscopic thymothymectomy due to MG associated with thymoma. At general anesthesia induction, 0.13 mg/kg of rocuronium completely suppressed the acceleromyographic train-of-four (TOF) response, enabling tracheal intubation. However, the electromyographic TOF count remained at 4. Intraoperatively, rocuronium was administered whenever the acceleromyographic TOF count reached 1, which was consistently delayed compared to the electromyographic TOF count of 1. After surgery, sugammadex 2 mg/kg was administered following confirmation of a TOF count of 2 on both monitors, which enabled successful extubation in the operating room. Conclusions This case suggests that combining electromyography with acceleromyography might be more beneficial than electromyography or acceleromyography alone in myasthenic patients, until further evidence is available.
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ISSN:2363-9024
2363-9024
DOI:10.1186/s40981-025-00803-x