II. Indications

  1. Ptosis evaluation in suspected Myasthenia Gravis

III. Contraindications

IV. Adverse Effects

  1. Increased Salivation
  2. Abdominal cramping
  3. Bradycardia
  4. Syncope
  5. Bronchospasm

V. Mechanism

  1. Edrophonium (Tensilon) is a rapid onset, short acting Acetylcholinesterase Inhibitor

VI. Preparation

  1. Perform with telemetry monitoring
  2. Atropine 0.5 mg IV prn Symptomatic Bradycardia

VII. Technique

  1. Edrophonium (10 mg/ml) 1 ml is drawn into a 1 cc syringe (tuberculin syringe)
  2. Inject edrophonium 2 mg (0.2 cc) IV every minute up to cummulative dose of 10 mg
  3. Stop when improvement in Ptosis is observed or 10 mg is reached (typically at 4-6 mg or 0.4 to 0.6 cc)

VIII. Interpretation

  1. Ptosis improvement with edrophonium is suggestive of Myasthenia Gravis

IX. Efficacy

  1. Test Sensitivity: 80-90%
  2. False Positives
    1. Motor Neuron disorders
    2. Brainstem tumor
    3. Compressive cranial Neuropathy

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