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Reversal of rocuronium‐induced neuromuscular blockade by pyridostigmine in patients with Duchenne muscular dystrophy
Author(s) -
MUENSTER TINO,
FORST JUERGEN,
GOERLITZ PETER,
SCHMITT HUBERT J.
Publication year - 2008
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2008.02417.x
Subject(s) - pyridostigmine , rocuronium , medicine , anesthesia , duchenne muscular dystrophy , adductor pollicis muscle , pyridostigmine bromide , neuromuscular monitoring , neuromuscular transmission , muscle relaxant , vecuronium bromide , myasthenia gravis , neuromuscular blockade , intubation , surgery , ulnar nerve , elbow
Summary Background: The aim of this study was to investigate the effect and safety of pyridostigmine for the reversal of a neuromuscular block (NMB) in patients with Duchenne muscular dystrophy (DMD). In patients with DMD recovery from a rocuronium‐induced NMB is markedly delayed. Methods: Fourteen DMD patients (aged between 11 and 19 years) scheduled for elective scoliosis repair were studied. Following tracheal intubation without muscle relaxant, all patients received a single dose of rocuronium 0.6 mg·kg −1 . NMB was monitored by acceleromyography at the adductor pollicis muscle. When the first twitch height ( T 1 ) of the train‐of‐four (TOF) had recovered to 25% seven patients received either pyridostigmine 0.1 mg·kg −1 (the anticholinergic drug with a long duration of action) or saline in a blinded manner. The times to attain TOF ratio of 0.9 were recorded. For comparison the Mann–Whitney U ‐test was used. Results: Recovery to TOF ratio of 0.9 was significantly ( P < 0.05) accelerated by pyridostigmine [84 (median), 57–141(range)] compared with controls (148, 84–243 min). The recovery time (time between T 1 of 25% and TOF of 90%) was also significantly ( P < 0.01) shortened by pyridostigmine (15, 8–49 vs 76, 43–144 min, respectively). Time to recovery of T 1 to 90% was not different between the groups (108, 63–134 vs 169. 61–208 min, respectively). Conclusions: Pyridostigmine 0.1 mg·kg −1 effectively reversed a rocuronium‐induced NMB in DMD patients.