Open AccessPotentiation of Rocuronium Bromide by Lithium Carbonate: A Case Report
Author(s) -
Naotaka Kishimoto,
Hideki Yoshikawa,
Kenji Seo
Publication year - 2020
Publication title -
anesthesia progress
Language(s) - English
Resource type - Journals
eISSN - 1878-7177
pISSN - 0003-3006
DOI - 10.2344/anpr-66-04-04
Subject(s) - rocuronium , rocuronium bromide , medicine , propofol , anesthesia , lithium carbonate , pancuronium bromide , lithium (medication) , vecuronium bromide , sugammadex , chemistry , ionic bonding , ion , organic chemistry
Lithium carbonate is a medication used for the management of various mental disorders. The present report describes a case of prolongation of rocuronium bromide in a patient concurrently taking lithium carbonate. A 64-year-old woman was scheduled to undergo cystectomy under general anesthesia. The patient took lithium carbonate (600 mg/d) for treatment of bipolar affective disorder. General anesthesia was induced with propofol, fentanyl, remifentanil, and sevoflurane. After loss of consciousness, rocuronium bromide (50 mg) was administered, and the trachea was intubated. Approximately 1 hour after the administration of rocuronium, the degree of residual muscle relaxant was evaluated using a nerve stimulation device. No muscle contraction occurred with train-of-four (TOF) stimulation. Following administration of sugammadex (200 mg) the TOF ratio increased to 95%. The ionic size of lithium is similar to that of sodium; therefore, lithium is transported into the cell with sodium. The resting membrane potential decreases, leading to a reduction in the height of the action potential. Thus, the effect of the remaining lithium may have been superimposed on the rocuronium neuromuscular blockade. Evaluation with a nerve stimulation device in patients taking lithium is crucial before extubation because of the risk of rocuronium potentiation.