title: A noninvasive method in the differential diagnosis of vecuronium-induced and magnesium-induced protracted neuromuscular block in a severely preeclamptic patient.
abstract: The occurrence of neuromuscular blockade and the resulting potentiation of muscle relaxants during magnesium sulfate (MgSO4) administration is well known. However, a method to differentiate the neuromuscular block induced by magnesium from that induced by curariform nondepolarizing muscle relaxant in the clinical setting has never been reported. We report a case in which the duration of action of 1 mg of vecuronium lasted 4 hours in a patient with severe preeclampsia whose serum magnesium level was in the therapeutic range. We believe this is a remarkable potentiation on record in the literature. We also describe a new, noninvasive method to assess magnesium-induced neuromuscular block when curariform muscle relaxant was given simultaneously.
authors.affiliation: Department of Anesthesiology, Harbor-UCLA Medical Center, Torrance 90509, USA.
authors.forename: W F
authors.initials: WF
authors.lastname: Kwan
authors.forename: C
authors.initials: C
authors.lastname: Lee
authors.forename: B J
authors.initials: BJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002585:Cesarean Section; D003937:Diagnosis, Differential; D004357:Drug Synergism; D004576:Electromyography / Q000187:drug effects / Q000379:methods; D005071:Evoked Potentials / Q000187:drug effects; D005260:Female; D006801:Humans; D008274:Magnesium / Q000097:blood; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000009:adverse effects*; D008991:Monitoring, Physiologic / Q000379:methods; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D011225:Pre-Eclampsia / Q000188:drug therapy / Q000503:physiopathology*; D011247:Pregnancy; D012032:Refractory Period, Electrophysiological / Q000187:drug effects; D014459:Ulnar Nerve / Q000187:drug effects / Q000502:physiology; D014673:Vecuronium Bromide / Q000009:adverse effects*
chemical_list: D000959:Antihypertensive Agents; D003473:Neuromuscular Nondepolarizing Agents; D008278:Magnesium Sulfate; D014673:Vecuronium Bromide; D008274:Magnesium