Prolonged neuromuscular block after a single dose of vecuronium in a patient with undiagnosed polyneuropathy and steroid myopathy
Rama-Maceiras, P.; Pensado, A.; Aymerich, H.; Molins, N.; Ferreira, T.A.; Vázquez-Fidalgo, A.
Revista Espanola de Anestesiologia y Reanimacion 46(1): 37-39
1999
ISSN/ISBN: 0034-9356 PMID: 10073081 Document Number: 508379
We report the case of a patient who had been receiving long-term corticoid therapy with undiagnosed polyneuropathy and steroid-related myopathy before experiencing prolonged neuromuscular blockade (lasting longer than 4 hours) after administration of a single dose of 0.08 mg/kg of vecuronium. Neuromuscular function was monitored by accelerometry with four-stimuli series. Many of the circumstances present in this case -such as prior administration of succinylcholine, the use of an inhaled anesthetic, kidney insufficiency and cyclosporin therapy- have been associated with increased duration of blockade induced by neuromuscular blockers, although durations reported have been shorter than that experienced by our patient. After electromyography and muscle biopsy, polyneuropathy and steroid-related myopathy were diagnosed. We conclude that neuromuscular blockers should be administered with extreme caution to patients with polyneuropathy and those undergoing long-term corticoid therapy, in order to prevent prolonged neuromuscular blockade.