[Prolonged neuromuscular block after mivacurium injection].
Mivacurium, a new short acting non depolarizing neuromuscular blocker, is metabolized, as suxamethonium, by plasma cholinesterase. Therefore its duration of action is increased in patients with reduced plasma cholinesterase activity. We report a case of prolonged neuromuscular block after an i.v. bolus of mivacurium (0.20 mg.kg-1) in a 69 year-old ASA II woman with an unrecognized cholinesterase deficiency undergoing a lumbar sympathectomy for arteriopathy of the lower limbs. The duration of the block was 6 h and plasma cholinesterase concentrations were very low (540 and 610 UI.L-1), as well as the dibucaine number (16%), which suggests an homozygous enzymatic deficiency. Mechanical ventilation and sedation were continued until spontaneous return of full neuromuscular function.
Viggiano
M
M
Département d'Anesthésie-Réanimation, C.H.U. Timone, Marseille.
Soler
C
C
Dumont
J C
JC
Pellissier
D
D
François
G
G
D000368:Aged; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods; D002091:Butyrylcholinesterase / Q000097:blood / Q000172:deficiency*; D005260:Female; D006801:Humans; D007546:Isoquinolines / Q000378:metabolism* / Q000494:pharmacology; D000077590:Mivacurium; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000378:metabolism* / Q000494:pharmacology; D013562:Sympathectomy
D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D002091:Butyrylcholinesterase
Bloc neuromusculaire prolongé après injection de mivacurium.