Neostigmine-induced prolonged neuromuscular blockade in a patient with atypical pseudocholinesterase.
A patient with unrecognized atypical pseudocholinesterase was given succinylcholine and then vecuronium before neuromuscular monitoring was instituted. Subsequently, when neostigmine and glycopyrrolate were given to reverse what was thought to be a nondepolarizing block, the patient became further relaxed, and his trachea could not be extubated for more than 10 hours. In this report, we discuss drug interactions, phase II block, and the importance of timely neuromuscular monitoring.
Ramirez
Jason G
JG
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
Sprung
Juraj
J
Keegan
Mark T
MT
Hall
Brian A
BA
Bourke
Denis L
DL
D002091:Butyrylcholinesterase / Q000378:metabolism*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D003558:Cystoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000009:adverse effects*; D019148:Neuromuscular Blockade / Q000379:methods; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D009468:Neuromuscular Diseases / Q000201:enzymology* / Q000209:etiology*; D007690:Polycystic Kidney Diseases / Q000150:complications / Q000601:surgery; D013390:Succinylcholine / Q000009:adverse effects; D013997:Time Factors; D014673:Vecuronium Bromide / Q000009:adverse effects
D002800:Cholinesterase Inhibitors; D009466:Neuromuscular Blocking Agents; D009388:Neostigmine; D014673:Vecuronium Bromide; D002091:Butyrylcholinesterase; D013390:Succinylcholine