pancuronium and Myasthenia-Gravis

Topics: Anesthesia, Inhalation; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Cholinesterase Inhibitors; Drug Antagonism; Drug Synergism; Humans; Hydrogen-Ion Concentration; Hyperkalemia; Myasthenia Gravis; Neostigmine; Neuromuscular Blocking Agents; Neuromuscular Depolarizing Agents; Neuromuscular Junction; Pancuronium; Pyridostigmine Bromide; Succinylcholine; Water-Electrolyte Balance

Topics: Anticonvulsants; Drug Resistance; Humans; Motor Neuron Disease; Myasthenia Gravis; Neuromuscular Junction; Neuromuscular Nondepolarizing Agents; Pancuronium; Vecuronium Bromide

It is well-known that anesthesia and surgery may precipitate muscle weakness in the patients with myasthenia gravis and some patient were not recognized as myasthenia until such episodes. A 74-year-old woman with increased sensitivity to pancuronium who, in spite of the very high titer of anti-acetylcholine receptor antibodies, showed no clinical manifestation of myasthenia gravis before operation. And computed tomographies revealed the presence of a thymoma in her anterior mediastinum. Although we have performed extended thymectomy, ptosis appeared 4 month after the operation. This patient might be called as "premyasthenic state" or "subclinical MG".

Topics: Aged; Autoantibodies; Female; Humans; Muscle Hypotonia; Myasthenia Gravis; Pancuronium; Receptors, Cholinergic; Thymoma; Thymus Neoplasms

Topics: Aged; Autoantibodies; Dose-Response Relationship, Drug; Female; Humans; Myasthenia Gravis; Pancuronium; Receptors, Nicotinic; Thymectomy

Topics: Adult; Aged; Electromyography; Female; Humans; Male; Middle Aged; Myasthenia Gravis; Neuromuscular Blocking Agents; Pancuronium; Time Factors; Vecuronium Bromide

The anaesthetic management of a patient suffering from carcinoid syndrome and myasthenia gravis is described including the successful treatment of a carcinoid attack with intravenous aprotonin. The differences between myasthenia gravis and the myasthenic (Eaton-Lambert) syndrome are considered and the rationale for the choice of vecuronium as the muscle relaxant is discussed.

Topics: Action Potentials; Aged; Anesthesia, General; Blood Pressure; Humans; Male; Malignant Carcinoid Syndrome; Myasthenia Gravis; Neuromuscular Blocking Agents; Pancuronium; Vecuronium Bromide

Topics: Humans; Myasthenia Gravis; Neuromuscular Blocking Agents; Pancuronium; Thymectomy; Vecuronium Bromide

Topics: Aged; Colectomy; Female; Humans; Myasthenia Gravis; Neuromuscular Blocking Agents; Pancuronium; Vecuronium Bromide

The use of vecuronium in six patients with myasthenia gravis undergoing thymectomy is described the train-of-four twitch technique was used to monitor neuromuscular function. The first two patients received an initial dose of 0.02 mg/kg and incremental doses of 4 micrograms/kg, which is in the order of one fifth of that normally used. Satisfactory depression of the first twitch of the train-of-four, however was not obtained and, therefore, in the remaining four patients the doses were doubled. At this dose satisfactory depression of the first twitch was achieved. Neostigmine 5.0 mg produced adequate reversal of residual neuromuscular blockade and the train-of-four twitch response recovered to normal levels. With reduced dosage and with careful neuromuscular monitoring, vecuronium can be used safely in the myasthenic patient.

Topics: Adolescent; Adult; Aged; Drug Administration Schedule; Drug Evaluation; Female; Humans; Male; Middle Aged; Muscle Contraction; Myasthenia Gravis; Neostigmine; Neuromuscular Blocking Agents; Pancuronium; Time Factors; Vecuronium Bromide

Anesthesiologists are now active in the diagnosis of unusual neurologic and neuromuscular disorders. Their skill derives both from a firm understanding of basic sciences and a facility with invasive procedures. Five representative cases are presented to illustrate the scope of diagnostic neuroanesthesiology and the endeavors of the neuroanesthesiologist outside the operating theater.

Topics: Adult; Aged; Anesthesiology; Cerebral Palsy; Consultants; Electromyography; Female; Humans; Male; Medicine; Middle Aged; Muscle Contraction; Muscle Spasticity; Myasthenia Gravis; Nervous System Diseases; Neurology; Neuromuscular Diseases; Pancuronium; Peripheral Nervous System Diseases; Specialization

Over a 10-year period 12,643 gynecologic surgical procedures were performed with the patients under general anesthesia. Succinylcholine was the muscle relaxant used in the majority of cases. Four of these patients developed prolonged postoperative apnea; the longest period of apnea was 6 hours. In one patient atypical cholinesterase was documented, and two of the patients were subsequently diagnosed as having myasthenia gravis. In the fourth case an etiology for the apnea was not demonstrated. A compilation of drugs in common clinical usage which interfere with neuromuscular transmission is included.

Topics: Adult; Apnea; Cholinesterases; Female; Genital Diseases, Female; Humans; Infant, Newborn; Middle Aged; Myasthenia Gravis; Pancuronium; Postoperative Complications; Retrospective Studies; Succinylcholine

Topics: Drug Interactions; Female; Humans; Middle Aged; Muscle Relaxants, Central; Myasthenia Gravis; Nitrogen Mustard Compounds; Pancuronium; Thiotepa

Topics: Adult; Child; Humans; Male; Myasthenia Gravis; Neostigmine; Neuromuscular Junction; Pancuronium; Thumb; Time Factors; Ulnar Nerve