Dual neuromuscular monitoring in juvenile myasthenia gravis undergoing thoracoscopic thymectomy - Report of four cases.

DOI:10.36210/BerMedJ/epub102014

Abstract

Differential neuromuscular blockade between muscles has been reported in healthy subjects, but information on this phenomenon in patients with juvenile myasthenia gravis (JMG) is scarce. The degree of muscle weakness between different muscles in MG patients varies from person to person. Single stimulations of the orbicularis occuli and pollicis longus muscles in the same patient are variable and do not give reproducible results. We anaesthetised four girls with MG (Osserman stage II-B) undergoing video-assisted thoracoscopic thymectomy (VATT). We administered propofol, fentanyl or remifentanil and vecuronium or cisatracurium during an average anaesthetic period of 155 minutes. Isoflurane was used in one case. A method of dual neuromuscular monitoring is described to assess intraoperative neuromuscular status more accurately. We conclude that undergoing VATT in addition to propofol, remifentanil and cisatracurium anaesthesia and double neuromuscular monitoring provides safe operating conditions and serves as a tool for early recovery in juvenile MG patients.