title: Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery.
abstract: A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery.
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Maulana Azad Medical College and Lok Nayak Hospital, Jawaharlal Nehru Marg, New Delhi - 110 002, India.
authors.forename: Alka
authors.initials: A
authors.lastname: Bhardwaj
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Dharmavaram
authors.forename: Sonia
authors.initials: S
authors.lastname: Wadhawan
authors.forename: Anjali
authors.initials: A
authors.lastname: Sethi
authors.forename: Poonam
authors.initials: P
authors.lastname: Bhadoria