Impairment of the antagonism of vecuronium-induced paralysis and intra-operative disopyramide administration.
A 63-year-old male was admitted to hospital for a cholecystectomy, vagotomy and gastro-enterostomy. Muscle paralysis was induced with 70 micrograms/kg vecuronium, followed by increments of 20 micrograms/kg when the initial twitch height returned to 25% of control. The patient received 3 doses of 10 mg disopyramide intravenously, on account of supraventricular ectopic beats, followed by an infusion of 25 mg/hour. Paralysis was reversed using 0.75 mg atropine and 2.5 mg neostigmine once the twitch height had returned spontaneously to 25% of its initial value. Fifteen minutes later, twitch height had returned to control value and the train-of-four was above 85%, but the responses to tetanic stimulation at 100 Hz and 50 Hz remained severely depressed (10% and 45%, respectively). The patient's trachea was extubated after 20 minutes, but residual fade was still observed. This impairment of neuromuscular transmission, detected only with high frequency stimulation, was present with a measured concomitant plasma level of disopyramide of 5.1 micrograms/ml.
Baurain
M
M
Service D'Anesthesiologie, Hopital Academique Erasme, Bruxelles, Belgium.
Barvais
L
L
d'Hollander
A
A
Hennart
D
D
D001285:Atropine / Q000494:pharmacology; D004206:Disopyramide / Q000494:pharmacology*; D004347:Drug Interactions; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects; D009388:Neostigmine / Q000494:pharmacology; D013997:Time Factors; D014673:Vecuronium Bromide / Q000037:antagonists & inhibitors*
D009388:Neostigmine; D001285:Atropine; D014673:Vecuronium Bromide; D004206:Disopyramide