Atracurium during induced hyperthermia.
During hyperthermic intraperitoneal chemotherapy (HIPEC), we observed a partial recovery from neuromuscular block in a hyperthermic patient after hours of monitored adequate surgical relaxation and continuous infusion of atracurium during normothermia. This recovery is indicative of the higher clearance of atracurium during hyperthermia. This case report emphasizes the clinical relevance of the well-known temperature dependence of the Hofmann elimination of atracurium. Moreover, this report illustrates the importance of monitoring muscle relaxation during HIPEC. Clinicians should be aware that the usual continuous infusion rate of atracurium at 0.3 mg.kg(-1).h(-1) may be inadequate in hyperthermic patients.
Jonker
Gersten
G
Department of Pediatric Anesthesiology, Wilhelmina Children's Hospital, University Medical Centre, P.O. Box 85090, Utrecht 3508 AB, The Netherlands.
Hoogenboom
Leo J
LJ
van Ramshorst
Bert
B
Bruins
Peter
P
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000767:Anesthesia, Epidural; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001279:Atracurium / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002277:Carcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery
D000970:Antineoplastic Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium
Anaesthesia. 1990 Nov;45(11):991
2252207
Anesthesiology. 2000 Jan;92(1):84-93
10638903
J Clin Oncol. 2003 Oct 15;21(20):3737-43
14551293
Br J Anaesth. 2003 Jul;91(1):160-1
12821581
Cancer Res. 1986 Nov;46(11):5599-601
3756907
Cancer Treat Res. 1996;81:51-61
8834575
Anesthesiology. 1986 Jul;65(1):6-12
3755306
Anesth Analg. 1995 May;80(5):1007-14
7726398
Clin Pharmacokinet. 1999 Jan;36(1):27-40
9989341