The effect of use of pyridostigmine and requirement of vecuronium in patients with myasthenia gravis.

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dc.contributor.authorTripathi, Men_US
dc.contributor.authorKaushik, Sen_US
dc.contributor.authorDubey, Pen_US
dc.date.accessioned2003-10-31en_US
dc.date.accessioned2009-06-02T10:15:56Z
dc.date.available2003-10-31en_US
dc.date.available2009-06-02T10:15:56Z
dc.date.issued2003-10-31en_US
dc.description.abstractCONTEXT: Patients with myasthenia gravis receive pyridostigmine, an anticholinesterase agent, as a part of therapy. These patients demonstrate a heightened sensitivity towards non-depolarising muscle relaxants. Continuing pyridostigmine till the day of the surgery or omitting it on the night before surgery could provide variable results with regards to the effect of vecuronium. AIMS: Myographic evaluation of a dose of vecuronium in patients with myasthenia gravis on pyridostigmine therapy. SETTING AND DESIGN: A randomised, double-blind, clinical study conducted in a teaching hospital. SUBJECTS AND METHODS: Medically (oral pyridostigmine) well-controlled adult patients with myasthenia gravis who were posted for thymectomy, were randomly divided into two groups. Patients in Group 1 received their last dose of pyridostigmine on the night before surgery while those in Group 2 received even the morning dose of the drug on the day of surgery. Neostigmine (1-2 mg) intravenously was used as rescue medication. Vecuronium (0.01 mg/kg) was used for intubation and muscle relaxation during trans-sternal thymectomy and its effect was reversed using neostigmine and atropine. RESULTS: Fourteen patients (7 in each group) belonging to both sexes were enrolled in the study. The intubating dose of vecuronium showed quicker onset time (155 sec or 2.7 min approx.) and peak effect (99% T1 suppression) in patients belonging to Group 1, and 3/7 (43%) complained of respiratory discomfort while waiting for surgery. By giving the morning dose of pyridostigmine (Group 2), an identical intubating dose of vecuronium showed relative resistance (peak effect-97% T1 suppression) and delayed onset time (198 sec approx.). However, the reversal was complete at the end of surgery in both the regimens. CONCLUSIONS: Omission of the pyridostigmine dose on the day of surgery predisposed patients with myasthenia gravis to the possibility of respiratory discomfort and sensitivity to vecuronium. Continued administration significantly prolonged the onset time of vecuronium and the patients required a higher dose of vecuronium.en_US
dc.description.affiliationDepartment of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India. mukesh_tripathi@hotmail.comen_US
dc.identifier.citationTripathi M, Kaushik S, Dubey P. The effect of use of pyridostigmine and requirement of vecuronium in patients with myasthenia gravis. Journal of Postgraduate Medicine. 2003 Oct-Dec; 49(4): 311-4; discussion 314-5en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/115400
dc.language.isoengen_US
dc.source.urihttps://www.jpgmonline.comen_US
dc.subject.meshAdulten_US
dc.subject.meshCholinesterase Inhibitors --therapeutic useen_US
dc.subject.meshFemaleen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMyasthenia Gravis --drug therapyen_US
dc.subject.meshNeuromuscular Nondepolarizing Agents --administration & dosageen_US
dc.subject.meshPyridostigmine Bromide --therapeutic useen_US
dc.subject.meshVecuronium Bromide --administration & dosageen_US
dc.titleThe effect of use of pyridostigmine and requirement of vecuronium in patients with myasthenia gravis.en_US
dc.typeClinical Trialen_US
dc.typeJournal Articleen_US
dc.typeRandomized Controlled Trialen_US
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