The Management of Neuromuscular Blockade in Patients with Myasthenia Gravis

DOI Web Site
  • FUJIMOTO Masafumi
    Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University
  • YAMAMOTO Tatsuo
    Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University

Bibliographic Information

Other Title
  • 重症筋無力症患者の筋弛緩マネージメント

Search this article

Abstract

<p>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.</p><p>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.</p>

Journal

Keywords

Details 詳細情報について

Report a problem

Back to top