Letters to the Editor
We congratulate Drs. Tobias and Atwood (1) for having collected as many as seven cases of Duchenne muscular dystrophy with mivacurium used for muscle relaxation. We deeply regret that this interesting study escaped our literature research. However, in retrospect, we still were unable to trace this paper in a data base like silver platter although Paediatric Anaesthesia is one of its source journals.
Tobias’ and Atwood’s article (1) represents a retrospective study based on the evaluation of patient records. We understand that there was no underlying uniform protocol for mivacurium administration and that neuromuscular transmission was monitored by visual or tactile evaluation of the train-of-four response. Residual neuromuscular was antagonized by neostigmine in all patients.
In contrast, our case report was subject to a prospective design characterized by (i) mivacurium administration according to a predetermined protocol, (ii) monitoring of neuromuscular transmission by simultaneous recording of both the evoked twitch tension and the evoked compound EMG until almost complete recovery of neuromuscular transmission, and (iii) no cholinesterase inhibitors used.
Because of this design, our report (2) retains originality, even in the light of Tobias’ and Atwood’s contribution (1). The latter, of course, deserves the credit of the very first publication on mivacurium in Duchenne muscular dystrophy (1). As far as comparable by study design, our data are in line with those of Tobias and Atwood (1).
Mahir Uslu MD
1. Tobias JD, Atwood T. Mivacurium in children with Duchenne muscular dystrophy. Paediatr Anaesth 1994; 4:57–60.
2. Uslu M, Mellinghoff H, Diefenbach C. Mivacurium for muscle relaxation in a child with Duchenne’s muscular dystrophy. Anesth Analg 1999; 89:340–1.