Mivacurium-induced neuromuscular block in adult patients suffering from CMT

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Can J Anaesth. 2006 Oct;53(10):984-8.

Mivacurium-induced neuromuscular block in adult patients suffering

from Charcot-Marie-Tooth disease.

Schmitt HJ, Munster T.

Department of Anesthesiology, Friedrich- Universitat,

Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.

PURPOSE: The response to non-depolarizing neuromuscular blocking

drugs is variable in patients with Charcot-Marie-Tooth (CMT) disease.

We speculated that CMT involvement of the monitored muscle may be

partially responsible for this inconsistency. We therefore

investigated the response to a standard dose of mivacurium

simultaneously assessed at adductor pollicis (AP) and orbicularis

oculi (OO) muscles in five patients with CMT.

CLINICAL FEATURES: Over a period of one year, five adult patients

with CMT scheduled for orthopedic surgery were studied. The right arm

and the right supercilliary arch were prepared for acceleromyographic

(AMG) neuromuscular monitoring. The AMG probes were attached at the

distal interphalangeal joint of the right thumb and on the right

upper eyelid to record the response of the AP and OO, respectively.

The ulnar nerve and upper part of the facial nerve were stimulated

supramaximally with repeated train-of-four stimuli (2 Hz, 0.2 msec)

every 15 sec via applied surface electrodes. Following monitor

calibration and induction of general anesthesia, mivacurium 0.2 mg.kg

(- 1) iv was given, and the time course of relaxation and recovery

were assessed. Times to spontaneous recovery of T1 to 25% were 15 +/-

3 vs 12 +/- 4 min in the AP and OO muscle groups respectively,

whereas times to 90% recovery were 23 +/- 5 vs 29 +/- 10 min,

respectively.

CONCLUSION: The onset and recovery characteristics associated with

mivacurium-induced neuromuscular block were similar at the AP and OO

muscle groups. A near normal response to mivacurium was observed in

this small series of patients with CMT disease.