Prolonged paralysis following suxamethonium and the use of neostigmine.
A case of prolonged neuromuscular block following the administration of suxamethonium is reported. Three hours after administration of suxamethonium, a well defined, recovering phase II block was demonstrated with a T4:T1 ratio of 0.25, and neostigmine was administered. Although the T4:T1 ratio was improved to 0.9, T1 remained at 25% of control, and significant paralysis persisted which responded to administration of cholinesterase. It is concluded that neuromuscular monitoring cannot reliably predict reversibility in such cases and that, even after 3 h, antagonism of prolonged suxamethonium block should commence with cholinesterase, followed by neostigmine if necessary.
James
M F
MF
Department of Anaesthesia, Medical School, University of Cape Town, Observatory, S. Africa.
Howe
H C
HC
D002802:Cholinesterases / Q000627:therapeutic use; D004576:Electromyography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use*; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D010243:Paralysis / Q000139:chemically induced*; D013390:Succinylcholine / Q000009:adverse effects*; D013997:Time Factors
D009466:Neuromuscular Blocking Agents; D009388:Neostigmine; D002802:Cholinesterases; D013390:Succinylcholine