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Clindamycin-induced neuromuscular blockade

O al Ahdal1, D R Bevan

  • 1Department of Anaesthesia, Vancouver Hospital, BC.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|July 1, 1995
PubMed
Summary
This summary is machine-generated.

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A large dose of clindamycin caused prolonged neuromuscular blockade in a patient, even after recovery from succinylcholine. This highlights clindamycin

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Report of a case involving a 58-year-old female patient with severe rheumatoid arthritis undergoing wrist arthrodesis.
  • Anesthesia was induced with thiopental and succinylcholine, with maintenance using nitrous oxide, oxygen, and isoflurane, alongside controlled ventilation.

Observation:

  • A significant overdose of intravenous clindamycin (2400 mg) was administered early in the surgical procedure.
  • Despite full recovery from succinylcholine, the patient exhibited profound neuromuscular blockade at the end of surgery, unresponsive to naloxone.

Findings:

  • Neuromuscular monitoring revealed a train-of-four ratio of 0.27, with minimal improvement after calcium chloride and edrophonium/neostigmine administration.
  • Prolonged neuromuscular blockade persisted for 9 hours, with spontaneous ventilation and tracheal extubation occurring 11 hours post-surgery.

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Implications:

  • High-dose clindamycin can induce severe, long-lasting neuromuscular blockade independent of other neuromuscular relaxants.
  • This case underscores the critical need for careful dosing and monitoring of clindamycin, particularly in patients with pre-existing conditions or those undergoing anesthesia.
  • Awareness of this potential adverse effect is crucial for anesthesiologists and critical care physicians to ensure patient safety and timely management.