Prolonged (more than ten hours) neuromuscular blockade after cardiac surgery: report of two cases.
OBJECTIVE
We examine two cases of prolonged neuromuscular blockade (NMB) after cardiac surgery. To the best of our knowledge, these are the first reported cases of complete paralysis lasting more than ten hours after surgery.


METHODS
We attribute the extended durations of NMB (more than ten hours) to high doses of NMB drugs in combination with magnesium sulphate and moderate renal failure. Advanced age, hepatic disease, aminoglycoside exposure, hypocalcemia, and possible interaction between rocuronium and pancuronium may have played minor roles.


CONCLUSIONS
We should avoid administering large doses of NMB agents, even in the context of planned postoperative ventilation. If NMB is not monitored intraoperatively in patients who are at risk of prolonged NMB, then train-of-four response should be measured in the intensive care unit. Adequate sedation should be provided until proper recovery of neuromuscular function is documented.
Olivieri
Lori
L
Department of Anesthesia, McGill University and McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.
Plourde
Gilles
G
D058186:Acute Kidney Injury / Q000150:complications; D000368:Aged; D000617:Aminoglycosides / Q000009:adverse effects; D000732:Androstanols / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D001011:Aorta / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D004347:Drug Interactions; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006996:Hypocalcemia / Q000150:complications; D008107:Liver Diseases / Q000150:complications; D008278:Magnesium Sulfate / Q000009:adverse effects; D008943:Mitral Valve / Q000601:surgery; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects; D010197:Pancuronium / Q000009:adverse effects; D010243:Paralysis / Q000139:chemically induced; D000077123:Rocuronium
D000617:Aminoglycosides; D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D008278:Magnesium Sulfate; D010197:Pancuronium; D000077123:Rocuronium