The Management of Neuromuscular Blockade in Patients with Myasthenia Gravis

We have reported that there were many patients with myasthenia gravis（MG）whose response to rocuronium was similar to patients without MG. The efficacy of the reversal of rocuronium-induced neuromuscular blockade by sugammadex has also been reported in patients with MG. Therefore, while the use of ro...

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Published inTHE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA Vol. 38; no. 2; pp. 230 - 236
Main Authors FUJIMOTO, Masafumi, YAMAMOTO, Tatsuo
Format Journal Article
LanguageJapanese
Published THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 15.03.2018
Subjects
Myasthenia gravis
Neuromuscular monitoring
Rocuronium
Sugammadex
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Summary:We have reported that there were many patients with myasthenia gravis（MG）whose response to rocuronium was similar to patients without MG. The efficacy of the reversal of rocuronium-induced neuromuscular blockade by sugammadex has also been reported in patients with MG. Therefore, while the use of rocuronium in patients with MG seems to have become safer, we experienced three unsuccessful postoperative extubations in patients with MG. Their response to rocuronium was increased and two of them could not achieve complete recovery of train-of-four（TOF）ratio after administration of sugammadex.We also experienced cases in which the residual neuromuscular blockade could not be detected by TOF ratio, which evaluated the function of the presynaptic nicotinic acetylcholine receptors. First twitch（T1）height of TOF stimulation monitoring, which can usually be omitted in patients without MG, is needed to evaluate the function of postsynaptic nicotinic acetylcholine receptors. Because the location of the impaired receptors（presynaptic or postsynaptic）and the degree of their impairment seem to differ among individual patients with MG, not only TOF ratio but T1 height must be monitored to evaluate the residual neuromuscular blockade in patients with MG.
ISSN:0285-4945
1349-9149
DOI:10.2199/jjsca.38.230