Early recognition of risk factors for persistent effects of vecuronium

Renal failure and hepatic failure are important risk factors for persistent effects of vecuronium. We report a case in which vecuronium therapy after cardiac arrest led to prolonged paralysis due to severe renal and hepatic dysfunction not apparent until after vecuronium therapy. Biochemical and electrophysiologic examinations confirmed that neuromuscular blockade due to accumulation of one active metabolite of vecuronium was the primary cause of the patient's paralysis. This case highlights the importance of recognizing progressive renal and hepatic dysfunction after cardiac arrest when contemplating treatment with vecuronium.