title: [Prolonged neuromuscular block after mivacurium: case report.].
abstract: OBJECTIVE
  With the introduction of new drugs with short action, there has been increase in the number of outpatient procedures. Mivacurium, with duration of action of 15-30 minutes and enzymatic metabolism has become the neuromuscular blocker of choice for these procedures. This case report aim at calling the attention to prolonged neuromuscular block after mivacurium and its management approaches.
  
  
  METHODS
  Patient scheduled for outpatient procedure presenting prolonged neuromuscular block after mivacurium. Diagnosis was confirmed by low plasma cholinesterase activity.
  
  
  CONCLUSIONS
  Preoperative laboratory screening, even including plasma cholinesterase activity testing, will not prevent the possibility of prolonged neuromuscular block due to possible qualitative enzymatic activity abnormality, and there is no recommendation for its systematic investigation. In the presence of this complication, patient should be sedated and maintained under mechanical ventilation until total muscle strength recovery. Laboratory tests should be requested for final diagnosis. It is the anesthesiologists duty to collect blood samples for quantitative and qualitative plasma cholinesterase tests. Patient and relatives should be counseled about the importance of the investigation to classify the atypical variant of plasma cholinesterase and its anesthetic complications.
authors.affiliation: Instituto Nacional do Câncer.
authors.forename: Karina Bernardi
authors.initials: KB
authors.lastname: Pimenta