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Impairment of the antagonism of vecuronium‐induced paralysis and intra‐operative disopyramide administration
Author(s) -
BAURAIN M.,
BARVAIS L.,
D'HOLLANDER A.,
HENNART D.
Publication year - 1989
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1989.tb11095.x
Subject(s) - medicine , anesthesia , disopyramide , neostigmine , pyridostigmine , atropine , paralysis , neuromuscular transmission , propofol , vecuronium bromide , concomitant , surgery , myasthenia gravis
Summary A 63‐year‐old male was admitted to hospital for a cholecystectomy, vagotomy and gastro‐enterostomy. Muscle paralysis was induced with 70 μg/kg vecuronium, followed by increments of 20 μg/kg when the initial twitch height returned to 2.5% of control. The patient received 3 doses of 10 mg disopyramide intravenously, on account of supraventricular ectopic beats, followed by an infusion of 2.5 mg/hour. Paralysis was reversed using 0.75 mg atropine and 2.5 mg neostigmine once the twitch height had returned spontaneously to 2.5% of its initial value. Fifteen minutes later, twitch height had returned to control value and the train‐of‐four was above 85%, but the responses to tetanic stimulation at 100 Hz and 50 Hz remained severely depressed (10% and 45%, respectively). The patient's trachea was extubated after 20 minutes, but residual fade was still observed. This impairment of neuromuscular transmission, detected only with high frequency stimulation, was present with a measured concomitant plasma level of disopyramide of 5.1 μg/ml.