Is Mivacurium Chloride Effective in Electroconvulsive Therapy? A Report of Four Cases, Including a Patient with Myasthenia Gravis

Electroconvulsive Therapy in Myasthenia Gravis

“…This case, along with the two others described recently, reports on patients with normal respiratory function and relatively few MG-related symptoms (6,7). It is still not known, however, how a compromised pulmonary function would influence recovery from ECT.…”

“…In another report, the case of a 68-year-old female with MG and depression successfully treated with ECT was described (6). Finally, Gitlin et al described a myasthenic patient who received multiple monitored ECT with mivacurium, a short acting non-depolarizing agent, for muscle relaxation (7). The most recent one of these three papers was published more than a decade ago.…”

A cross-over, post-electroconvulsive therapy comparison of clinical recovery from rocuronium versus succinylcholine

“…Moreover, succinylcholine is a potential triggering drug for malignant hyperthermia as well as neuroleptic malignant syndrome. There are reports of successful use of intermediate-acting, non-depolarizing muscle relaxants such as mivacurium, atracurium, and rapacuronium during ECT procedures in this patient population [5][6][7][8][9][10].…”

Reversal of Neuromuscular Block With a Selective Relaxant-Binding Agent: Sugammadex

“…9,12,14 Cyclodextrins are pharmacologically inert and have no action at nicotinic or muscarinic receptors and do not behave like an acetylcholinesterase inhibitor, nor do they carry their associated concerns for side effects. 8,10 The majority of treatment-related adverse events were mild to moderate in intensity, but most importantly, there is no significant change in heart rate and arterial blood pressure. 9,12 The most frequently reported adverse events were signs associated with decreased anesthetic level as evidenced by increased incidence of grimacing, sucking, coughing on the tube, and an increase in Bispectral Index after administration of sugammadex, 14 a phenomenon not unexpected since NMB is well known to add to the depth of anesthesia.…”

“…Patients with myasthenia gravis are notorious for being challenging in their reaction to muscle relaxants and reversal agents. 8 Other medications and anesthetics can affect the potency, duration, and clearance of NMBs. 7 The ideal antagonist of NMBs should not only be rapid in onset with minimal or no side effects but also should be able to antagonize deep blocks and be effective in the presence of potent anesthetics and against a wide range of muscle relaxants and disease states.…”