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TRACHEAL INTUBATION WITHOUT NEUROMUSCULAR BLOCK IN PATIENTS WITH MYASTHENIA GRAVIS

Munemura, Y. MD; Iwasaki, H. MD; Tsuchida, H. MD; Kawana, S. MD; Namiki, A. MD

doi: 10.1097/00000539-199802001-00044
Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Anesthesia/OR Economics
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Department of Anestheiology, Sapporo University School of Medicine.

Abstract S44

A wide range of sensitivities has been reported for patients with Myasthenia Gravis (MG) to neuromuscular blocking agents. It is difficult to estimate its proper induction dose and use antagonist. It has been reported that propofol may provide adequate conditions for intubation without the need for neuromuscular relaxants. This study was designed to assess intubating conditions with propofol and fentanyl without neuromuscular relaxant in patients with MG.

PATIENTS AND METHODS: Hospital ethics committee approval was obtained to study 6 patients with MG aged 24-68 yr, scheduled for extended thymectomy. All patients were premedicated with midazolam 1.5-2.5 mg [center dot] kg-1 i.m. and atropine 0.5 mg [center dot] kg-1 i.m. 30min before anesthesia. Three minutes after administration of fentanyl 2 [micro sign]g [center dot] kg-1, a standard induction dose of propofol 2-3 mg [center dot] kg-1 was given over 30sec and Train-of-four-ratio (TOFR) of the adductor pollicis muscle by ulner nerve stimulation was measured (Table 2). Tracheal intubation was attempted 60sec after administration of propofol and three aspects of intubating conditions were assessed on a four-point scale (Table 1): ease of intubation, vocal cord position and degree of coughing on insertion of the tracheal tube.

Table 2

Table 2

Table 1

Table 1

RESULTS: (Table 2)

We found satisfactory intubating conditions in all patients.

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CONCLUSIONS:

It was concluded that anesthesia induction with propofol 2-3 mg [center dot] kg-1 and fentanyl 2 [micro sign]g [center dot] kg-1 provided a satisfactory condition for tracheal intubation without neuromuscular relaxant in patients with MG.

© 1998 International Anesthesia Research Society