Anaesthesia, atracurium and Duchenne muscular dystrophy

Increases in heart rate and systolic blood pressure in anesthetized dogs affected with X‐linked muscular dystrophy after cisatracurium administration: a retrospective study

“…To the authors’ knowledge, this is the first report describing significant autonomic responses potentially associated with the administration of cisatracurium in anesthetized subjects affected with X‐linked muscular dystrophy. An anecdotal report described the use of atracurium to facilitate endotracheal intubation in a 12‐year boy affected with DMD (7). The absence of vagolysis with atracurium combined with the ability to allow reversal to occur without using neostigmine and atropine was recognized as a significant advantage, and atracurium was regarded as the most suitable NDNMB to use in patients with DMD.…”

“…As cardiac autonomic function is usually altered in patients with DMD, the use of nondepolarizing neuromuscular blockers (NDNMB) with vagolytic actions (i.e., gallamine, pancuronium) should also be avoided as they may induce tachycardia and precipitate cardiac failure. Atracurium, an intermediate‐acting benzylisoquinolinium NDNMB, has been suggested as a good alternative for these patients as it lacks vagolytic actions and undergoes Hofmann’s degradation (7). However, research and/or clinical data are missing to support this recommendation.…”

Mivacurium in children with Duchenne muscular dystrophy

“…Due to this concern and the presence of pre-existing muscle weakness, complete restoration of muscle strength is desired prior to the discontinuation of ventilatory support. To facilitate this task, the use of intermediate acting non-depolarizing muscle relaxants is recommended (Rosewarne 1986).…”

Onset and duration of mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy †

“…The effect of non-depolarizing muscle relaxants, however, remains to be elucidated in these patients. Though the effect of various muscle relaxants has been reported anecdotally, [5][6][7][8][9][10][11] these reports are conflicting and indicate either normal or increased sensitivity to nondepolarizing muscle relaxants. In a recent investigation in DMD patients we recorded a prolonged onset time and a markedly prolonged spontaneous recovery after a single standard dose of rocuronium.…”