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Prolonged neuromuscular blockade with atracurium.

M D Bizzarri-Schmid, S P Desai

Canadian Anaesthetists' Society Journal

|March 1, 1986

Summary

A patient experienced prolonged neuromuscular weakness after receiving atracurium during anesthesia. Neostigmine failed to reverse the blockade, requiring extended mechanical ventilation. This case highlights a rare adverse reaction to atracurium.

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Area of Science:

Anesthesiology
Pharmacology

Background:

General anesthesia involves the use of anesthetic agents and muscle relaxants.
Atracurium is a non-depolarizing neuromuscular blocking agent commonly used in anesthesia.
Neuromuscular blockade reversal is typically achieved with agents like neostigmine.

Observation:

A 29-year-old woman received 105 mg of atracurium over 2.5 hours during general anesthesia.
The neuromuscular blockade persisted postoperatively and was not fully reversed by neostigmine.
Mechanical ventilatory support was required for three hours after surgery.

Findings:

This case represents the first reported instance of prolonged neuromuscular weakness following atracurium administration.
The patient had no adverse reactions to succinylcholine before or after this event.
Standard reversal protocols with neostigmine were ineffective in this specific patient.

Implications:

This case suggests a potential for rare, prolonged neuromuscular blockade with atracurium in susceptible individuals.
Further investigation into the mechanisms of prolonged atracurium-induced neuromuscular blockade may be warranted.
Anesthesiologists should be aware of this potential complication and consider alternative reversal strategies or prolonged monitoring.

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