RESPONSE TO ATRACURIUM AND MIVACURIUM IN A PATIENT WITH CHARCOT-MARIE-TOOTH-DISEASE

Purpose: We studied the neuromuscular effects of both atracurium and m ivacutium in a patient with Charcot-Marie-Tooth disease (CMTD) during nitrous oxide-oxygen-alfentanil-propofol anaesthesia, Neuromuscular bl ockade was monitored electromyographically. Train-of-four stimulation (2Hz @ 20 sec intervals) was delivered to the ulnar nerve throughout t he period of observation. Clinical features: A 17-yr-old man with the diagnosis of CMTD was presented twice for two different orthopaedic su rgical procedures, The CMTD had been diagnosed since childhood, Neurol ogical examination revealed distal wasting of the upper and lower limb s, generalised absence of reflexes and decreased sensation in a stocki ng distribution. In both anaesthetics, induction was carried out with alfentanil and propofol, and anaesthesia was maintained with nitrous o xide in oxygen, alfentanil and propofol infusion, The patient demonstr ated a normal response to both atracurium and mivacurium, Onset time a nd the maximum block attained after atracurium and mivacurium were 240 and 210 sec, and 97% and 99% inhibition of T1 (the first twitch of TO F stimulation), respectively. Recovery of T1 to 10% of the control val ue occurred 30 and 11.5 min after the administration of atracurium and mivacurium, respectively The patient made uneventful recoveries after both anaesthetics. Conclusion: There was no evidence of prolonged res ponse to atracurium and mivacurium in our patient with CMTD.