RESPONSES TO NONDEPOLARIZING NEUROMUSCULAR BLOCKERS AND SUCCINYLCHOLINE IN VON RECKLINGHAUSEN NEUROFIBROMATOSIS

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.