title: Postoperative reparalysis after rocuronium following nebulized epinephrine.
abstract: OBJECTIVE
  We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologically reversed with edrophonium after paralysis with rocuronium.
  
  
  RESULTS
  A 12-yr-old girl developed postoperative reparalysis following the intraoperative administration of rocuronium. A total of 0.92 mg.kg-1 rocuronium was administered. After surgery, pharmacological reversal was achieved with 20 mg edrophonium with 0.15 mg atropine sulfate iv 35 min after the last administration of rocuronium. Muscular relaxation was monitored using an ulnar peripheral nerve stimulator (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Hz were present. In the recovery room, following nebulized epinephrine, the patient became apneic. The patient was paralyzed and an ulnar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate.
  
  
  CONCLUSIONS
  Postoperative reparalysis following rocuronium may be a cause of postoperative respiratory distress. The definitive diagnosis is made using PNS and observing the response to pharmacological reversal. Nebulized epinephrine may have a previously undescribed role in the development of postoperative reparalysis.
authors.affiliation: Department of Anesthesiology, University of Wisconsin Clinical Science Center, Madison 53792-3272, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Arndt
authors.forename: T
authors.initials: T
authors.lastname: Gerry
authors.forename: P
authors.initials: P
authors.lastname: White
mesh_terms: D000280:Administration, Inhalation; D000732:Androstanols / Q000009:adverse effects*; D002648:Child; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D010243:Paralysis / Q000139:chemically induced*; D011183:Postoperative Complications / Q000209:etiology*; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D004837:Epinephrine