Delayed recovery following atracurium: a case report

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pharmacology

Background:

• Neuromuscular blocking agents, such as atracurium, are commonly used during general anesthesia to facilitate endotracheal intubation and surgical manipulation.
• Neostigmine is a standard reversal agent used to counteract the effects of non-depolarizing neuromuscular blockers, aiming to restore spontaneous respiration.
• Patient temperature is a critical physiological parameter that can influence drug metabolism and recovery from anesthesia.

Observation:

• A 41-year-old woman received 19 mg of atracurium during a 2-hour abdominal surgery under general anesthesia.
• Following surgery, spontaneous respiration could not be achieved despite the administration of neostigmine for reversal.
• The patient's core body temperature was recorded below 35°C, indicating accidental hypothermia.

Findings:

• Delayed recovery of neuromuscular function and spontaneous respiration occurred in the patient.
• The inability to achieve adequate reversal with neostigmine was correlated with the presence of unrecognized accidental hypothermia.
• Hypothermia significantly impaired the expected efficacy of the anticholinesterase reversal agent.

Implications:

• Unrecognized hypothermia can lead to prolonged recovery from anesthesia and potential postoperative respiratory complications.
• Anesthesiologists must maintain vigilance regarding patient temperature, especially during lengthy procedures, to prevent and manage hypothermia.
• Proactive temperature management is crucial for optimizing patient outcomes and ensuring timely recovery from neuromuscular blockade.