Background In patients with Duchenne muscular dystrophy (DMD) the response to nondepolarizing muscle relaxants is scarcely documented and conflicting. The current study was conducted to determine the time to peak effect and the time for complete spontaneous recovery after a single dose of 0.6 mg/kg of rocuronium in patients with DMD. Methods Twenty-four patients (12 with DMD, 12 controls, aged 10-16 yr) were studied. All patients were anesthetized with propofol and fentanyl/remifentanil. Neuromuscular transmission was monitored by acceleromyography. After induction all patients received a single dose of 0.6 mg/kg of rocuronium. The complete time course of onset and spontaneous recovery were recorded Results Significant (P < 0.01) increase in the onset times to 95% neuromuscular block was observed in DMD patients (median, 203 s; range, 90-420 s) compared with controls (median, 90 s; range, 60-195 s). The time between rocuronium administration and recovery of first twitch of the train-of-four to 90% was significantly (P < 0.01) prolonged in DMD compared with controls (median, 132 min; range, 61-209 min versus 39 min; 22-55 min). The recovery index was also significantly prolonged in the DMD group compared with controls (median, 28 min, range, 15-70 min versus 8 min; 3-14 min). Conclusions The most striking and surprising result of this study is the delayed onset of blockade in DMD after a standard dose of rocuronium. This effect should be kept in mind in situations when a rapid airway protection is necessary in DMD patients. The documented very long recovery from rocuronium-induced block emphasizes the need for careful assessment of neuromuscular function in DMD patients.

Friedreich's ataxia is a rare hereditary neurodegenerative disease caused by a defect in the gene that encodes a mitochondrial protein called frataxin. We report the use of rocuronium 0.6 mg kg(-1) in two adolescent girls with Friedreich's ataxia undergoing propofol-sufentanil-oxygen-air anaesthesia for spinal surgery. Neuromuscular transmission was monitored using acceleromyography, and onset and recovery times were recorded. The clinical duration of rocuronium was comparable to that of children without neuromuscular disease (25% recovery T(1)=44 and 24 min for patients 1 and 2 respectively).

These results support the assumption that mivacurium-induced neuromuscular block is prolonged in patients with DMD.

The similar peak effect in both groups does not confirm the thesis of rocuronium having a higher potency in DMD patients. The documented very long recovery after the ED(95) of rocuronium emphasizes the need for careful assessment of neuromuscular function in DMD patients.

In our small series of patients with CMT the clinical duration of mivacurium-induced neuromuscular block was similar to data known from children without neuromuscular disease.

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aged thirteen years, who resided in Foundrystreet, Bolton, and assisted his father at the trade of a woodturner, was engaged, one afternoon, in that occupation, when, in consequence of his foot slipping, he fell upon a circular saw, of about twenty inches in diameter, which inflicted a severe wound, extending from the anterior border of the masseter muscle, passing along the ramus and angle of the inferior maxilla, across the neck, a little below the mastoid process of the temporal bone, to the superior transverse ridge of the occipital bone, and terminating near the protuberance of that bone. He was carried to my surgery by two men, bleeding profusely, and in a state of great exhaustion.The injury was on the right side of the neck and face; the wound was very deep; the edges were uneven, and jagged by the teeth of the saw; the muscles were considerably lacerated;and several branches of the external carotid artery were cut across.The occipital bone was deeply grooved for more than two inches in extent. The haemorrhage, which was very profuse, was not arrested before the application of about six ligatures. After cleaning the wound, which contained a quantity of hair, and several spiculse of bone, the edges were brought partially into apposition with adhesive plaster, light dressings and bandages were applied, and the boy was conveyed home in a cab, a distance short of half a mile. I visited him early on the following morning, and found him greatly agitated. His mother informed me that he had passed a restless night-not so much from pain resulting from the wound, as excitement and alarm. I directed him to be kept quiet, a dose of castor oil to be administered, and his regimen to be lightly antiphlogistic. In the evening, owing to the agitation continuing, I prescribed a pill of calomel, opium, and tartar-emetic.On the third day he was reported to have had some sound sleep, and his appearance was certainly more tranquil, although the pulse was quick, the skin dry and hot, tongue furred, and he complained of slight pain in the head. The oil had operated twice, freely. He complained of the wound feeling stiff and uneasy. There had been no further bleeding since the first dressing.On the fourth day there was less febrile disposition, but the integuments near the wound were swollen, red, and painful; a slight erysipelatous blush was extending over that side of the neck and face. I removed the bandages and dressings. The surface of the wound had a livid appearance, and was covered with an ichorous, foetid discharge. Simple dressing was applied, and a bread-and-water poultice. The citrate of potash, with small doses of the antimonial solution, were administered every four or six hours. As he complained of the weight of the poultice, an evaporating lotion was substituted, the effect of which (as he expressed himself) was very grateful.----On the succeeding day the fever was more abated, the parts near the injury were considerably less swollen, the pain had subsided, the redness about the neck and face was not so extensive,...