title: Prolonged relaxant effects of vecuronium in patients with deliberate hypermagnesemia: time for caution in cesarean section.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Yoshida
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Itoh
authors.forename: Kei
authors.initials: K
authors.lastname: Nagaya
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takino
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Sugawara
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Okamura
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takahashi
mesh_terms: 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*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D008278:Magnesium Sulfate; D014673:Vecuronium Bromide; D008274:Magnesium