Mg. Richardson et al., RESPONSES TO NONDEPOLARIZING NEUROMUSCULAR BLOCKERS AND SUCCINYLCHOLINE IN VON RECKLINGHAUSEN NEUROFIBROMATOSIS, Anesthesia and analgesia, 82(2), 1996, pp. 382-385
Patients with type 1 neurofibromatosis (NF-1) have been reported to ha
ve prolonged responses to nondepolarizing (ND) neuromuscular blockers
(NMBs). Responses to succinylcholine (SCh) have been described as incr
eased, decreased, or normal. The purpose of this study was to assess r
esponses to NMBs in NF-1 patients in order to determine the clinical s
ignificance of abnormal responses. We retrospectively identified all N
F-1 patients who received anesthetics at Strong Memorial Hospital betw
een January 1, 1984 and December 31, 1994. We then reviewed all anesth
etic records to classify responses to NMBs as normal, abnormal, or ind
eterminate. Records of 114 anesthetics provided to 44 NF-1 patients we
re reviewed. Nondepolarizing NMBs were used during 73 anesthetic cases
in 38 patients. Responses were normal in 69 cases and indeterminate i
n 4 (3 in patients with normal responses during other anesthetics). SC
h was used during 42 anesthetic cases in 23 patients. Responses were n
ormal in all but one case (indeterminate) in a patient who had had oth
er documented normal responses. Standard milligram per kilogram doses
of NMBs were used in all cases, and in none was there evidence of abno
rmal response. The risk of abnormal response to NMBs in individuals wi
th NF-1 appears to be minimal. We recommend no alteration in dosing of
either SCh or ND NMBs in patients with NF-1.