[Prolonged neuromuscular block induced by mivacurium in a patient treated with cyclophosphamide].
A case is reported of prolonged neuromuscular block after mivacurium chloride for laparoscopic cholecystectomy, in a 45 years old patient, treated with cyclophosphamide for a Wegener's granulomatosis. The neuromuscular function monitoring by train-of-four showed a duration of action of 75 min after an intubation dose of 0.20 mg.kg-1. Additional bolus of 1 mg, corresponding to 25% of usual doses, every 10 or 15 min, were sufficient for maintaining muscle relaxation. Spontaneous recovery, without any antagonization, lasted 40 min for a TOF ratio (T4/T1) > or = 70%. Recovery index from 25 to 75% were 13 min. Plasma butyrilcholinesterases activity were reduced to a level of 50%. With reference to literature about succinylcholine, the responsibility of cyclophosphamide is likely, and discussed. This observation shows the value of monitoring the neuromuscular transmission.
Vigouroux
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Service d'Anesthésie Urgences et Réanimation, CHR Rangueil, Toulouse.
Voltaire
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L
D000477:Alkylating Agents / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods; D002091:Butyrylcholinesterase / Q000097:blood; D017081:Cholecystectomy, Laparoscopic; D003520:Cyclophosphamide / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy*; D006801:Humans; D007546:Isoquinolines / Q000378:metabolism* / Q000494:pharmacology; D008875:Middle Aged; D000077590:Mivacurium; D016343:Monitoring, Intraoperative; D009469:Neuromuscular Junction / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents / Q000378:metabolism* / Q000494:pharmacology
D000477:Alkylating Agents; D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D003520:Cyclophosphamide; D002091:Butyrylcholinesterase
Curarisation prolongée après mivacurium chez une patiente traitée par cyclophosphamide.