Stillwell R, Mangar D, Turnage W S
Nurse Anesth. 1993 Dec;4(4):193-7.
The relaxograph findings are presented in two patients. In the first, isoflurane alone is administered, and mivacurium with isoflurane is administered to the second patient with myasthenia gravis. A significantly lower dose of mivacurium is required. It was noticed that the T4:T1 ratio was 100% after mivacurium and reversal agent, but T1 did not return to normal. In the patient that only received isoflurane, T1 was 60% to 70% of the baseline, indicating the neuromuscular blocking effects of isoflurane. These cases illustrate that inhalation anesthetics are adequate for muscle relaxant effects, and if neuromuscular blockers are necessary, then a lower dose of nondepolarizer should be administered, and the patient carefully monitored. Mivacurium appears to be an ideal agent for neuromuscular blockade in myasthenia gravis as long as careful neuromuscular blockade is performed.
本文展示了两名患者的松弛仪检查结果。第一位患者仅使用异氟烷，第二位重症肌无力患者使用异氟烷和米库氯铵。所需的米库氯铵剂量显著更低。注意到使用米库氯铵和逆转剂后，T4:T1比值为100%，但T1未恢复正常。在仅接受异氟烷的患者中，T1为基线的60%至70%，表明异氟烷具有神经肌肉阻滞作用。这些病例表明，吸入麻醉剂足以产生肌肉松弛效果，若需要使用神经肌肉阻滞剂，则应给予较低剂量的非去极化肌松药，并对患者进行仔细监测。只要进行仔细的神经肌肉阻滞，米库氯铵似乎是重症肌无力患者神经肌肉阻滞的理想药物。
