Vecuronium Neuromuscular Blockade in a Child With Mitochondrial Myopathy

Wiesel, Saul; Bevan, Joan C.; Jacob, Samuel; Donati, François

doi:10.1213/00000539-199105000-00020

Cited by 16 publications

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“…On the one hand succinylcholine has been suggested to be safe, 4,5 on the other hand a prolonged recovery after succinylcholine has been observed. 4 An uneventful anaesthetic course has been seen only for vecuronium, 4,6,7 pancuronluna s,s and atracurium. 4,6,7,9 An increased sensitivity to rocuronium has not been reported before in patients with mitochondrial myopathy, s The normal duration of neuromuscular blockade after 0.6 mg.kg -1 rocuronium is said to be 29 • 20 min.…”

Section: Discussionmentioning

confidence: 99%

“…4 An uneventful anaesthetic course has been seen only for vecuronium, 4,6,7 pancuronluna s,s and atracurium. 4,6,7,9 An increased sensitivity to rocuronium has not been reported before in patients with mitochondrial myopathy, s The normal duration of neuromuscular blockade after 0.6 mg.kg -1 rocuronium is said to be 29 • 20 min. l~ Thus, our observation of 60 min is above the upper end of the normal range, disregarding the great variation in response to neuromuscular blocking agents in individual patients) 1 The prolonged effect to rocuronium may be explained with altered pharmacokinetics and dynamics due to the combination of a chronic metabolic acidosis (lactate increase already at low levels of effort) and a compensatory respiratory alcalosis.…”

Section: Discussionmentioning

confidence: 99%

“…l~ Thus, our observation of 60 min is above the upper end of the normal range, disregarding the great variation in response to neuromuscular blocking agents in individual patients) 1 The prolonged effect to rocuronium may be explained with altered pharmacokinetics and dynamics due to the combination of a chronic metabolic acidosis (lactate increase already at low levels of effort) and a compensatory respiratory alcalosis. 4 The prolongation of action of atracurium may be explained with a possible potentiation of atracurium by rocuronium. 12,13…”

Section: Discussionmentioning

confidence: 99%

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Increased sensitivity to rocuronium and atracurium in mitochondrial myopathy

et al. 1998

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Increased sensitivity to rocuronium and atracurium in mitochondrial myopathyPurpose: To describe the prolonged effect of the intermediate-acting, non-depolarising neuromuscular blocking agents rocuronium and atracurium in a 29-yr-old apparently healthy woman. Clinical features: Because of abdominal pain the patient was scheduled for explorativelaparoscopic pelvic examination. General anaesthesia was induced with fentanyl, midazolam and propofol. Muscle relaxation was achieved with 0.6 mg.kg-' rocuronium. Anaesthesia was maintained with nitrous oxide and propofol. Two Hz train-of-four stimulation every 15 sec evoked no twitch responses until 60 min after rocuronium. Further relaxation was achieved with 0.075 mg.kg-' atracurium after which twitch responses recurred after 45 min. Fifteen minutes later neuromuscular blockade was successfully reversed with atropine and neostigmine. The postanaesthetic course was uneventful. Because of the increased sensitivity to rocuronium and atracurium the patient was re-evaluated postoperatively. History revealed occasional double vision, fatigue, muscle cramps, stiffness and myoglobinuria. Clinical neurological examination showed ptosis, tremor, ataxia and bradydiadochokinesia. A standardised lactate stress testing on a bicycle was pathological and, after muscle biopsy, the diagnosis of mitochondrial myopathy was established. Conclusion: An increased sensitivity to rocuronium and atracurium may occur in patients with mitochondrial myopathy. In these patients appropriate dosing of muscle relaxants and adequate monitoring of the neuromuscular blockade are required. If an increased sensitivity to rocuronium and atracurium occurs in an apparently healthy subject, further neurological investigations should follow.Objectif : D&rire I'effet prolong~ des inhibiteurs neuromusculaires non d~polarisants ~ action interm~diaire, rocuronium et atracurium, chez une femme de 29 ans apparemment en bonne sant~. Aspects cliniques : La patiente a 6t~ admise pour un examen laparoscopique exploratoire du bassin ~ la suite de douleurs abdominales. I'anesth&ie g~n&ale a ~t~ induite avec du fentanyl, du midazolam et du propofol. La relaxation musculaire a ~t~ obtenue avec 0,6 mg'kg ~ de rocuronium. I'anesth&ie a ~t~ maintenue avec du protoxyde d'azote et du propofol. Une stimulation de deux Hz en train-de-quatre ~ toutes les 15 secondes n'a pas d&lench~ de contraction musculaire avant 60 minutes suivant radministration du rocuronium. Une relaxation suppl6mentaire a ~t~ obtenue, avec 0,075 mg.kg -~ d'atracurium, apr~s laquelle les contractions musculaires ont reparu 45 minutes plus tard. Apr~s quinze minutes, le bloc neuromusculaire &ait renvers~ avec succ& avec ratropine et la n(.~ostigmine. I'~volution postanesth~sique a ~t~ sans complication. La patiente a ~t6 ~valu6e de nouveau apr& I'intervention ~ cause de la sensibilit~ accrue au rocuronium. I'histoire a r~v~l~ une diplopie occasionnelle, de la fatigue, des crampes musculaires, de la raideur et de la myoglobinurie. ~examen neurologique clinique a ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Increased sensitivity to rocuronium and atracurium in mitochondrial myopathy

et al. 1998

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“…Induction of anaesthesia should be undertaken with various considerations in mind. Sensitivity to intravenous induction agents has been described with thiopentone and etomidate ( 14, 15), although thiopentone ( 16, 17), propofol ( 18), and ketamine ( 19), have all been used safely in patients with mitochondrial disease. However, inhalational induction may avoid potential problems associated with this sensitivity.…”

Section: Introductionmentioning

confidence: 99%

Anaesthesia and mitochondrial disease

Wallace

Perndt

Skinner

1998

Pediatric Anesthesia

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Mitochondrial diseases, or encephalomyopathies, are an uncommon, heterogeneous group of disorders with variable clinical course and presentation. Many of these patients present for surgery, or undergo anaesthesia in the course of investigation of their illness. Unfortunately, little information exists on their management in anaesthetic texts and the literature. We report on the anaesthetic management of a paediatric patient with mitochondrial disease, and briefly discuss the pathophysiology and anaesthetic implications of these disorders.

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“…Also, Wiesel et al . (6) and Kushikata et al . (7) reported normal response to vecuronium in patients with mitochondrial myopathy.…”

Section: Discussionmentioning

confidence: 97%

Resistance to cisatracurium in a patient with MELAS syndrome

Aouad

Gerges

Baraka

2005

Pediatric Anesthesia

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There are conflicting reports on the response of mitochondrial myopathy patients to the neuromuscular blocking drugs, showing either normal response or marked sensitivity. We present a patient with MELAS syndrome who underwent Nissen fundoplication and gastrojejunostomy. Marked resistance to the nondepolarizing muscle relaxant, cisatracurium was observed. The anesthesia management, as well as the various causes of resistance to cisatracurium in this patient are discussed.

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Vecuronium Neuromuscular Blockade in a Child With Mitochondrial Myopathy

Cited by 16 publications

References 0 publications

Increased sensitivity to rocuronium and atracurium in mitochondrial myopathy

Increased sensitivity to rocuronium and atracurium in mitochondrial myopathy

Anaesthesia and mitochondrial disease

Resistance to cisatracurium in a patient with MELAS syndrome

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