[Prolonged neuromuscular block induced by mivacurium in a patient treated with cyclophosphamide]

Ann Fr Anesth Reanim. 1995;14(6):508-10. doi: 10.1016/s0750-7658(05)80493-9.
[Article in French]

Abstract

A case is reported of prolonged neuromuscular block after mivacurium chloride for laparoscopic cholecystectomy, in a 45 years old patient, treated with cyclophosphamide for a Wegener's granulomatosis. The neuromuscular function monitoring by train-of-four showed a duration of action of 75 min after an intubation dose of 0.20 mg.kg-1. Additional bolus of 1 mg, corresponding to 25% of usual doses, every 10 or 15 min, were sufficient for maintaining muscle relaxation. Spontaneous recovery, without any antagonization, lasted 40 min for a TOF ratio (T4/T1) > or = 70%. Recovery index from 25 to 75% were 13 min. Plasma butyrilcholinesterases activity were reduced to a level of 50%. With reference to literature about succinylcholine, the responsibility of cyclophosphamide is likely, and discussed. This observation shows the value of monitoring the neuromuscular transmission.

Publication types

  • Case Reports

MeSH terms

  • Alkylating Agents / therapeutic use
  • Anesthesia Recovery Period
  • Anesthesia, General / methods
  • Butyrylcholinesterase / blood
  • Cholecystectomy, Laparoscopic
  • Cyclophosphamide / therapeutic use
  • Drug Interactions
  • Female
  • Granulomatosis with Polyangiitis / drug therapy*
  • Humans
  • Isoquinolines / metabolism*
  • Isoquinolines / pharmacology
  • Middle Aged
  • Mivacurium
  • Monitoring, Intraoperative
  • Neuromuscular Junction / drug effects
  • Neuromuscular Nondepolarizing Agents / metabolism*
  • Neuromuscular Nondepolarizing Agents / pharmacology

Substances

  • Alkylating Agents
  • Isoquinolines
  • Neuromuscular Nondepolarizing Agents
  • Mivacurium
  • Cyclophosphamide
  • Butyrylcholinesterase