Neuromuscular effects of sevoflurane in patients with myasthenia gravis

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Abstract
The current study evaluated the neuromuscular responses following administration of sevoflurane in 14 patients with myasthenia gravis (MG) (I–IIb in Osserman's classification) scheduled for thymectomy and in 11 control patients (ASA I–II) who underwent elective surgery. The electromyographic (EMG) response of the abductor digiti minimi was measured following train-of-four (TOF) stimulation of the ulnar nerve every 20 s. After induction of anesthesia with a combination of 3–4 mg·kg−1 thiopental and 1–2 μg·kg−1 fentanyl with 66% N2O and oxygen, an inspired concentration of 4% sevoflurane was administered via a face mask for 7 min. Anesthesia was maintained during surgery with 66% N2O in oxygen and with 1 minimum alveolar concentration (MAC) of end-tidal concentration of sevoflurane. The T1 (the amplitude of the first response) values decreased more profoundly in the MG patients than in the control patients at the end of surgery (PP=0.029). Our results indicate that MG patients have an increased neuromuscular sensitivity to sevoflurane.

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