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Increased sensitivity to a nondepolarizing muscle relaxant in a patient with acquired neuromyotonia
Author(s) -
Ginsburg Greg,
Forde Ryan,
Martyn Jeevendra A.J.,
Eikermann Matthias
Publication year - 2009
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.21322
Subject(s) - neuromyotonia , rocuronium , muscle relaxant , medicine , anesthesia , muscle relaxation , acetylcholine receptor , agonist , electromyography , acetylcholine , neuromuscular junction , neuroscience , receptor , physical medicine and rehabilitation , psychology , intubation , antibody , immunology
Neuromyotonia is a disorder of hyperexcitability of the peripheral nerve. It has electromyographic features of spontaneous, continuous, irregularly occurring doublets, or multiplets of motor unit potential discharges. Neuromyotonia is characterized by both myokymic and neuromyotonic discharges. To our knowledge, this is the first report in the literature to assess the sensitivity of skeletal muscle to a nondepolarizing muscle relaxant drug, rocuronium, in a woman with acquired neuromyotonia. She had a past medical history notable for prolonged postoperative paralysis following anesthesia. The patient showed increased sensitivity to the neuromuscular effects of rocuronium. This increase in sensitivity may be explained by downregulation of acetylcholine receptors in response to chronic high agonist (acetylcholine) concentrations. If patients with neuromyotonia receive anesthesia, we recommend that smaller doses of a nondepolarizing muscle relaxant be administered, accompanied by monitoring of neuromuscular function, so as to provide optimal muscle relaxation while avoiding overdose and prolonged postoperative recovery. Muscle Nerve 40: 139–142, 2009