Increased sensitivity to atracurium in a child with Duchenne's muscular dystrophy
Huang, F.Y.; Sun, W.Z.; Wang, K.C.; Pai, S.Y.
Ma Zui Xue Za Zhi 28(2): 223-227
1990
ISSN/ISBN: 0254-1319 PMID: 2215111 Document Number: 4243
Duchenne's muscular dystrophy (DMD) is the most common myopathy in children. It characterizes as pelvicrural and shoulder girdle weakness since early childhood. With cardiac muscle involvement and progressive muscle destruction, patients die of heart failure and respiratory failure at their teens and twenties. Mortality and morbidity related to anesthesia among DMD patients are high. Although the pathology lies in the defected muscle membrance as well as myofibril in stead of neuromuscular junction, depolarizing muscle relaxant was associated with a high incidence of acute rhabdomyolysis and malignant hyperthermia. Use of non-depolarizing neuromuscular blocking agents was considered to be a safe practice among DMD patients. Various drugs had been used without any abnormal responses. Sensitivity to vecuronium was normal, however, the recovery time was significantly prologed. There was no report about the experience with atracurium among DMD patients. We reported an abnormal response to atracurium in a child with DMD. In this study, use of atracurium in a child with DMD revealed an increased sensitivity and prolonged recovery index. We recommend that continuous monitor for neuromuscular junction blockade should routinely be used in anesthetizing patients with DMD.
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