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Prolonged (more than ten hours) neuromuscular blockade after cardiac surgery: report of two cases

Un blocage neuromusculaire prolongé (plus de dix heures) après une intervention en cardiochirurgie: présentation de deux cas

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Abstract

Purpose

We examine two cases of prolonged neuromuscular blockade (NMB) after cardiac surgery. To the best of our knowledge, these are the first reported cases of complete paralysis lasting more than ten hours after surgery.

Clinical features

We attribute the extended durations of NMB (more than ten hours) to high doses of NMB drugs in combination with magnesium sulphate and moderate renal failure. Advanced age, hepatic disease, aminoglycoside exposure, hypocalcemia, and possible interaction between rocuronium and pancuronium may have played minor roles.

Conclusion

We should avoid administering large doses of NMB agents, even in the context of planned postoperative ventilation. If NMB is not monitored intraoperatively in patients who are at risk of prolonged NMB, then train-of-four response should be measured in the intensive care unit. Adequate sedation should be provided until proper recovery of neuromuscular function is documented.

Résumé

Objectif

Présenter deux cas de blocage neuromusculaire prolongé (BNM) après une intervention cardiaque. Selon nos connaissances, c’est la première publication de cas de paralysie complète qui dure plus de dix heures après l’opération.

Éléments cliniques

Nous croyons que la durée prolongée du BNM (plus de dix heures) est le résultat de fortes doses de médicaments de BNM combinées au sulfate de magnésium et à une insuffisance rénale modérée. L’âge avancé, la maladie hépatique, l’exposition aux aminoglycosides, l’hypocalcémie et une interaction possible entre le rocuronium et le pancuronium peuvent avoir jouer des rôles mineurs.

Conclusion

Nous devons éviter d’administrer de fortes doses d’agents de BNM, même quand une ventilation postopératoire planifiée. Si le BNM n’est pas surveillé chez les patients à risque de BNM prolongé, la réponse en train-de-quatre doit alors être mesurée à l’unité des soins intensifs. Une sédation adéquate doit être donnée jusqu’à ce qu’une reprise convenable de la fonction neuromusculaire soit prouvée.

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Author information

Correspondence to Gilles Plourde.

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Olivieri, L., Plourde, G. Prolonged (more than ten hours) neuromuscular blockade after cardiac surgery: report of two cases. Can J Anesth 52, 88 (2005). https://doi.org/10.1007/BF03018587

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Keywords

  • Intensive Care Unit Admission
  • Sufentanil
  • Pancuronium
  • Rocuronium
  • Magnesium Sulphate