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Extended neuromuscular blockade with mivacurium following pancuronium

Published online by Cambridge University Press:  04 August 2006

J. R. Sneyd
Affiliation:
Anesthesiology Department,1G323 University Hospital, 1500 E Med Center Drive, Ann Arbor, MI 48109-0048, UK. Department of Anaesthesia, Derriford Hospital, Derriford Road, Plymouth, PL6 8DH, UK.
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Abstract

A 21-year-old female weighing 55 kg was anaesthetized for facial reconstruction. After an initial bolus of pancuronium 5 mg and top-up doses of 2 mg at 135 min and 1 mg at 290 min and 335 min, no further relaxant was given for 130 min at which time neuromuscular transmission appeared fully recovered with a full train-of-four twitches and a sustained response to 50 Hz stimulation of the posterior tibial nerve. Subsequently, a single dose of mivacurium 8 mg(2 X ED95) produced extended paralysis with no response to train-of-four stimulation for 85 min. The prolonged effect of mivacurium may have been because of inhibition of plasma cholinesterase by pancuronium. The serum cholinesterase activity 12 h after surgery was 0.38 units mL−1 (normal range 0.65–1.0 units mL−1). There was no evidence of atypical choylinesterase.

Type
Original Article
Copyright
1996 European Society of Anaesthesiology

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