Unusual Prolonged Recovery of Succinylcholine - induced Neuromuscular Block Following Neostigmin / 대한마취과학회지

ABSTRACT

We report a case of slow recovery of the neuromuscular block induced by succinylcholine (SCC) immediately after administration of neostigmine for the reversal of pancuronium. Left hemithyroidectomy was performed in a 4l kg female patient under general endotracheal inhalation anesthesia with 50%-nitrous oxide and 2.0%-enflurane. Four mg of pancuronium was used for muscular relaxation to facilitate the controlled ventilaion on the anesthesia ventilator. At the end of the operation, one and a half hours from the injection of pancuronium, 10 mg of pyridostigmine was administered to reverse the neuromuscular blockade. Five minutes later, 25 mg of succinylcholine was given for reintubation. Following this event, train-of-four stimuli was applied under the uncalibrated mode with Datex Relaxograph because apnea followed by SCC appeared for more than 30 minutes. Neuromuscular monitoring revealed fade to less than 50% of the T, ratio. The ventilator was applied for the recovery of neuromuscular blockade for one hour. There was no more late complications after transfer to the ward. The literature relating to this iatrogenic complication and phase II block after SCC is reviewed and discussed.