PROLONGED NEUROMUSCULAR BLOCKADE

We are presenting a case of prolonged neuromuscular blockade afteremergency cesarean section. A 34 years old, young lady with no previous history of any systemic illness includingneuromuscular disorder reported in the operation t heatre for cesarean section. She was offered standard protocol forgeneral anaesthesia using thiopentone sodium i/v for induction, suxamethonium i/v for intubation, and pancuroniumbromide i/v for intra-operative relaxation. Intra-operative analgesia was obtained with nalbuphine i/v (after delivery ofchild). Ampicillin and gentamicin i/v were used as prophylactic antibiotics. The patient failed to regain spontaneousbreathing effort after a lapse of two hours since the last dose of pancuronium bromide. Laboratory investigationsincluding complete blood picture, urea, creatinine, electrolytes (calcium, sodium, potassium) revealed anemia andsevere hypocalcemia. She was given fresh whole blood and calcium gluconate intravenously, in addition to othersupportive measures like ventilatory support using SIMV mode of ventilation with 40% O2. Patient started regainingbreathing effort after about 12 hours and was extubated after about 15 hours of artificial ventilation with little residualneuromuscular blocking effect. She was kept in the ICU for the next 24 hours for observation and was discharged fromICU the next day with full recovery. Conclusion Patient probably suffered from the interaction between gentamicin andpancuronium bromide, that was further potentiated by hypocalcemia and anaemia. She was given supportive care alongwith replacement of calcium, and anaemia was corrected by fresh whole blood transfusion. Patient recovereduneventfully and was discharged from ICU the next day.