Recurrence of Neuromuscular Blockade after Reversal of Vecuronium in a Patient Receiving Polymyxin/Amikacin Sternal Irrigation

Kronenfeld, Mark; Thomas, Stephen J.; Turndorf, Herman

doi:10.1097/00000542-198607000-00019

Cited by 16 publications

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“…The surgeon was fully aware of the side effects of the anesthetics and potential drug‐drug interactions. Aminoglycoside antibiotics may increase the blood levels of succinylcholine or cisatracurium, resulting in an increase in the risk of related adverse events . In addition, sugammadex may reduce the blood levels and effects of hormonal contraceptives, and increase the risk of breakthrough bleeding .…”

Section: Discussionmentioning

confidence: 99%

“…Aminoglycoside antibiotics may increase the blood levels of succinylcholine or cisatracurium, resulting in an increase in the risk of related adverse events. 26 In addition, sugammadex may reduce the blood levels and effects of hormonal contraceptives, and increase the risk of breakthrough bleeding. 27 Therefore, we excluded from the analysis patients receiving antibiotics such as amikacin or tobramycin and hormonal contraceptives such as estradiol, norethindrone, and levonorgestrel.…”

Section: Discussionmentioning

confidence: 99%

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Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

et al. 2016

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“…Despite major complications, namely, nephrotoxicity, ototoxicity apart from interactions with other drugs, aminoglycoside antibiotics still remain first choice for some of the life threatening situations like septicemia . The aminoglycosides not only potentiate 6,7,8,9 the neuromuscular blocking effects of non depolarizing muscle relaxants but also have some neuromuscular blocking effects of their own. It is suggested that aminoglycosides inhibit the signal-transduction pathway by interaction with the inositol polyphospholipids, thereby inhibiting the production of second messenger molecules .…”

Section: 4mentioning

confidence: 99%

Prolonged Neuromuscular Blockade

Asghar¹,

Boota²

2006

TPMJ

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We are presenting a case of prolonged neuromuscular blockade afteremergency cesarean section. A 34 years old, young lady with no previous history of any systemic illness includingneuromuscular disorder reported in the operation t heatre for cesarean section. She was offered standard protocol forgeneral anaesthesia using thiopentone sodium i/v for induction, suxamethonium i/v for intubation, and pancuroniumbromide i/v for intra-operative relaxation. Intra-operative analgesia was obtained with nalbuphine i/v (after delivery ofchild). Ampicillin and gentamicin i/v were used as prophylactic antibiotics. The patient failed to regain spontaneousbreathing effort after a lapse of two hours since the last dose of pancuronium bromide. Laboratory investigationsincluding complete blood picture, urea, creatinine, electrolytes (calcium, sodium, potassium) revealed anemia andsevere hypocalcemia. She was given fresh whole blood and calcium gluconate intravenously, in addition to othersupportive measures like ventilatory support using SIMV mode of ventilation with 40% O2. Patient started regainingbreathing effort after about 12 hours and was extubated after about 15 hours of artificial ventilation with little residualneuromuscular blocking effect. She was kept in the ICU for the next 24 hours for observation and was discharged fromICU the next day with full recovery. Conclusion Patient probably suffered from the interaction between gentamicin andpancuronium bromide, that was further potentiated by hypocalcemia and anaemia. She was given supportive care alongwith replacement of calcium, and anaemia was corrected by fresh whole blood transfusion. Patient recovereduneventfully and was discharged from ICU the next day.

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“…Many animal studies and clinical case reports have shown that aminoglycoside antibiotics either inhibit acetylcholine release at the motor nerve terminal [2][3][4] or increase the duration of the actions of neuromuscular blocking agents and inhalational anesthetics [5][6][7][8]. The clinical significance of these actions lies in the resulting respiratory depression which may lead to prolonged postoperative apnea.…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular Blocking Effects of the Aminoglycoside Antibiotics Arbekacin, Astromicin, Isepamicin and Netilmicin on the Diaphragm and Limb Muscles in the Rabbit

Liu¹,

Kato²,

Hashimoto³

2001

Pharmacology

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Aminoglycoside antibiotics are known to produce a depression of neuromuscular function which may cause prolonged paralysis of respiratory muscles. However, differences in the effects of aminoglycoside antibiotics on diaphragm and limb muscles have not been investigated. We determined the neuromuscular blocking effects of the aminoglycoside antibiotics arbekacin sulfate, astromicin sulfate, isepamicin sulfate and netilmicin sulfate on the diaphragm, tibialis anterior and soleus muscles in anesthetized rabbit nerve-muscle preparations. Neuromuscular block was assessed by mechanical response with single twitch stimulation. Cumulative drug dose-response curves were obtained for three different muscles in 24 rabbits. The mean ED₅₀ and ED₉₅ of the antibiotics in diaphragm, tibialis anterior and soleus muscles were calculated. The neuromuscular blocking effects of all the aminoglycosides on ED₅₀ and ED₉₅ values were in the order of soleus > tibialis anterior > diaphragm, and soleus > diaphragm > tibialis anterior, respectively. The ED₅₀ ratios for the tibialis anterior and soleus muscles were approximately 1.5 and 2.7 times greater than that for the diaphragm.

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Recurrence of Neuromuscular Blockade after Reversal of Vecuronium in a Patient Receiving Polymyxin/Amikacin Sternal Irrigation

Cited by 16 publications

References 0 publications

Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

Prolonged Neuromuscular Blockade

Neuromuscular Blocking Effects of the Aminoglycoside Antibiotics Arbekacin, Astromicin, Isepamicin and Netilmicin on the Diaphragm and Limb Muscles in the Rabbit

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