[Prolonged paralysis after long-term administration of vecuronium in the intensive care unit].
A 51-year-old woman with renal failure requring hemodialysis received a total of 446 mg of vecuronium over a period of 4 days to help mechanical ventilation and developed generalized muscle weakness after its discontinuation. It took 2 wks to wean her from mechanical ventilation and 3 wks for her to be able to walk. She did not receive drugs which might alter neuromuscular transmission such as corticosteroid and aminoglycoside antibiotics. Electromyogram and nerve conduction studies were normal. We believe that the cause is the accumulation of vecuronium and active metabolites due to renal failure. The case suggests that we should minimize the duration of neuromuscular block in patients with renal failure by aggressive use of sedatives and analgesics and the optimization of ventilator settings.
Tanaka
Osamu
O
Department of Anesthesia, Nishi-Kobe Medical Center, Kobe 651-2273.
Akai
Hanae
H
Takekida
Sayoko
S
Tanaka
Yasushi
Y
Wake
Mikiko
M
Iijima
Katsuhiro
K
Horikawa
Yoshio
Y
Ijichi
Kazuko
K
D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D010243:Paralysis / Q000139:chemically induced*; D051437:Renal Insufficiency / Q000378:metabolism; D012121:Respiration, Artificial; D014673:Vecuronium Bromide / Q000008:administration & dosage* / Q000009:adverse effects* / Q000378:metabolism
D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide