title: Prolonged succinylcholine action during electroconvulsive therapy (ECT) after cytarabine, vincristine, and rituximab chemotherapy.
abstract: Succinylcholine is a depolarizing neuromuscular blocker frequently used during electroconvulsive therapy. In most patients, the duration of paralysis is brief, allowing for spontaneous respiration shortly after the therapy. We report a case of delayed return of neuromuscular function after succinylcholine administered during electroconvulsive therapy in a 72-year-old man receiving cytarabine, vincristine, and rituximab chemotherapy for chronic lymphocytic leukemia. We hypothesize that an interaction between succinylcholine and one of the chemotherapeutic agents caused the prolongation of paralysis and believe that this is the first reported case of prolonged duration of succinylcholine following this regimen of chemotherapy. Despite this unexpected prolonged neuromuscular blockade, the patient could be treated uneventfully, with attention paid to his respiratory support and with subsequent succinylcholine dose titration to effect.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA. ethan.bryson@mountsinai.org
authors.forename: Ethan O
authors.initials: EO
authors.lastname: Bryson
authors.forename: Amy S
authors.initials: AS
authors.lastname: Aloysi
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Perez
authors.forename: Dennis
authors.initials: D
authors.lastname: Popeo
authors.forename: Charles H
authors.initials: CH
authors.lastname: Kellner
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D006801:Humans; D008297:Male; D009467:Neuromuscular Depolarizing Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D000069283:Rituximab; D013390:Succinylcholine / Q000493:pharmacokinetics / Q000627:therapeutic use; D013997:Time Factors; D014750:Vincristine / Q000627:therapeutic use*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D009467:Neuromuscular Depolarizing Agents; D003561:Cytarabine; D000069283:Rituximab; D014750:Vincristine; D013390:Succinylcholine