Baraka A S, Taha S K, Kawkabani N I
Department of Anesthesiology, American University of Beirut, Lebanon.
Can J Anaesth. 2000 Jun;47(6):562-5. doi: 10.1007/BF03018948.
To describe the influence of sevoflurane anesthesia on cisatracurium neuromuscular block in a myasthenic patient undergoing thymectomy.
A myasthenic patient (Osserman IIB) was managed for one year before surgery with 60 mg pyridostigmine qid, 50 mg immuran tid and 30 mg prednisone therapy. Pyridostigmine was interrupted three months before surgery, and five sessions of plasmapheresis were done within 13 days before surgery. The neuromuscular response was monitored by Datex electromyographic response to train-of-four stimulation of the ulnar nerve. Sevoflurane 4% decreased the T1/C ratio by 20%. Administration of 0.025 mg x kg(-1) cisatracurium, during sevoflurane anesthesia, was followed by complete neuromuscular block for 45 min. Discontinuation of sevoflurane resulted, after 10 min, in recovery of the T which reached T1/C ratio of 50% after 30 min.
The marked sensitivity of this myasthenic patient to 0.5 x ED95 of cisatracurium can be attributed to potentiation of cisatracurium neuromuscular block by sevoflurane, as evidenced by the reappearance of the first twitch of the train-of-four response 10 min after sevoflurane was discontinued.
描述七氟烷麻醉对一名行胸腺切除术的重症肌无力患者顺式阿曲库铵神经肌肉阻滞的影响。
一名重症肌无力患者（Osserman IIB型）术前接受了一年的治疗，口服吡啶斯的明60毫克，每日4次，硫唑嘌呤50毫克，每日3次，泼尼松30毫克。术前3个月停用吡啶斯的明，术前13天内进行了5次血浆置换。通过Datex肌电图对尺神经四个成串刺激的反应来监测神经肌肉反应。4%的七氟烷使T1/C比值降低了20%。在七氟烷麻醉期间给予0.025毫克/千克的顺式阿曲库铵后，出现了45分钟的完全性神经肌肉阻滞。停用七氟烷10分钟后，T波恢复，30分钟后T1/C比值达到50%。
该重症肌无力患者对0.5倍ED95的顺式阿曲库铵具有显著敏感性，这可归因于七氟烷增强了顺式阿曲库铵的神经肌肉阻滞作用，七氟烷停用10分钟后四个成串刺激反应中的第一个抽搐再次出现即证明了这一点。
