Related Experiment Videos
[Prolonged neuromuscular block after mivacurium injection]
M Viggiano1, C Soler, J C Dumont
1Département d'Anesthésie-Réanimation, C.H.U. Timone, Marseille.
Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1995
Summary
Mivacurium, a short-acting neuromuscular blocker, can cause prolonged effects in patients with cholinesterase deficiency. This case highlights the importance of recognizing this deficiency for safe anesthesia.
Area of Science:
- Anesthesiology
- Pharmacology
- Biochemistry
Background:
- Mivacurium is a short-acting, non-depolarizing neuromuscular blocker metabolized by plasma cholinesterase.
- Reduced plasma cholinesterase activity can prolong the duration of action for mivacurium.
- Cholinesterase deficiency is an important consideration in patients receiving neuromuscular blocking agents.
Observation:
- A 69-year-old female with an unrecognized cholinesterase deficiency received intravenous mivacurium.
- The patient underwent a lumbar sympathectomy for lower limb arteriopathy.
- Prolonged neuromuscular blockade lasting 6 hours was observed post-administration.
Findings:
- Plasma cholinesterase concentrations were significantly low (540 and 610 UI.L-1).
- A low dibucaine number (16%) indicated a likely homozygous enzymatic deficiency.
- The prolonged block necessitated continued mechanical ventilation and sedation.
Implications:
- This case underscores the critical need for screening or awareness of cholinesterase deficiency before administering mivacurium.
- Anesthesiologists must be prepared for extended neuromuscular blockade in susceptible patients.
- Understanding enzymatic variations is crucial for optimizing patient safety and anesthetic management.