Mariona FME, Cordero LD, Chávez RMA

Language: Spanish
References: 12
Page: 33-36
PDF size: 40.74 Kb.

ABSTRACT

Prolonged mivacurium-induced neuromuscular blockade after infusion. A case report. The choice of neuromuscular relaxant is a matter of importance during a surgical event. A 63 year old woman, with no surgical or pathological antecedents, was programmed for laparatomy, and received anesthetic induction with propofol, fentanyl, and mivacurium. Maintenance was obtained with O2/Sevoflurane and an infusion of fentanil and mivacurium. After 1 hr of the neuromuscular relaxant infusion there were no respons at the train -of-four stimulus, so it was discontinued. The surgery ended and the patient showed no change, so she was transfered to the intensive unit care for mechanical ventilatory assistance. She was extubated 20hrs after the neuromuscular relaxant infusion was stopped. Laboratory tests were obtained and a disminished plasmatic cholinesterase and % dibucaine-inhibition were found. The patient went home after 12 days of hospital care with no consequences, and pertinent recommendations were given about future anesthetic proccedures.

REFERENCES

1. White, P: Textbook of Endovenous Anesthesia. En Lien CA, Belmont MR, Rubin L, SavareseJJ: Benzylisoquinoline Compounds. 1era. ed. Williams & Wilkins. 1997. Pags: 319-343.

2. Lien CA, Schmith VD, Embree PB: The pharmacokinetics and pharmacodynamics of the stereoisomers of mivacurium in patientes receiving nitrous oxide/opioid/barbiturate anesthesia. Anesthesiology 1994;80:1296-1302.

3. Hart PS, McCarthy GJ, Brown R: The effect of plasma cholinesterase activity on mivacurium infusion rates. Anaesth-Analg 1995; 80: 760-763.

4. Ahn EK, Bai SJ, Cho BJ: The infusion rate of mivacurium and its spontaneous neuromuscular recovery in magnesium-treated parturients. Anaesth- Analg 2998 Mar; 86 (3): 523-526.

5. Stern, R: Drugs, Diseases & Anesthesia. 1era. Ed. Lippincott -Raven. 1997. Pags: 355-363.

6. Ostergaard D, Jensen FS, Jensen E: Mivacurium-induced neuromuscular blockade in patients with atypical plasma cholinesterase. Acta Anaesthesiol Scand 1993; 37: 314-318.

7. Bevan DR: Prolonged mivacurium-induced neuromuscular block. Anaesth–Analg 1993; 77: 4-6.

8. Petersen RS, Bailey PL, Kalameghan R: Prolonged neuromuscular block after mivacurium. Anaesth- Analg 1993;76: 194-196.

9. Lien CA, Belmont MR, Wray DL: Pharmacokinetics and dynamics of mivacurium during spontaneous and anticholinesterase-facilitated recovery. Anesthesiology 1995; 83: A896.

10. Bownes PB, Hartman GS, Chiscolm D: Antagonism of mivacurium blockade by purified human butyryl cholinesterase in cats. Anesthesiology 1992; 77: A909.

11. Naguib M, Abdulatif M, Al -Ghambdi A: Dose-response relationships for edrophonium and neostigmine antagonism of mivacurium-induced neuromuscular block. Br J Anaesth 1993; 71: 709-714.

12. Hart PS, Wright PMC, Brown R: Edrophonium increases mivacurium concentratiosn during constant mivacurium infusion, and large doses minimally antagonize paralysis. Anesthesiology 1995; 82: 912-918.