Prolonged relaxant effects of vecuronium in patients with deliberate hypermagnesemia: time for caution in cesarean section.
We present two cases showing significantly prolonged action of vecuronium from magnesium treatment after general anesthesia for urgent cesarean section. The serum magnesium levels were maintained at a therapeutic range for severe eclampsia in one patient (5.6 mg.dl(-1)) and for tocolysis in another with placenta previa totalis (6.9 mg.dl(-1)). The obstetrics-specific emergency in each patient led us to proceed with general anesthesia but using reduced-dose vecuronium, which failed to prevent prolongation of the neuromuscular block. As a result, the patients received prolonged mechanical ventilation. Our cases underscore the need for anesthesiologists as well as obstetricians to be aware of the prolongation of the action of nondepolarizing muscle relaxants as a result of magnesium treatment.
Yoshida
Akiko
A
Department of Anesthesiology, Tohoku University Hospital, Sendai, Japan.
Itoh
Yosuke
Y
Nagaya
Kei
K
Takino
Kazuya
K
Sugawara
Jun-Ichi
J
Murakami
Takashi
T
Okamura
Kunihiro
K
Takahashi
Masahiko
M
D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D008274:Magnesium / Q000097:blood*; D008278:Magnesium Sulfate / Q000627:therapeutic use; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D011247:Pregnancy; D013997:Time Factors; D015145:Tocolysis; D014673:Vecuronium Bromide / Q000494:pharmacology*
D003473:Neuromuscular Nondepolarizing Agents; D008278:Magnesium Sulfate; D014673:Vecuronium Bromide; D008274:Magnesium