Administration of Atracurium in a Patient Recovering from Organophosphate Poisoning / 대한마취과학회지

ABSTRACT

A 67-year-old woman accidentally ingested insecticide 3 months ago and received ventilator care for 1 month. Thereafter, she developed tracheal stenosis combined with a tracheal-esophageal fistula, and she was scheduled to receive a tracheal resection anastomosis. We anesthetized her with atracurium under the monitoring of an accelerograph and she did not represent any prolonged respiratory paralysis postoperatively. We administered atracurium 10 mg twice initially and then gave additional 5 mg boluses when the TOF ratio became greater than 0.5. The total dose of administered atracurium was 40 mg and total duration of anesthesia was 360 minutes. We did not extubate her in the operating room in spite of complete recovery from atracurium to preoperative status because her lung condition was not very good preoperatively and severe necK flexion was done for the anastomosis. In the intensive care unit, the patient's condition progressively deteriorated with the development of adult respiratory distress syndrome and acute renal failure. Despite vigorous organ specific support, she discharged hopelessly 24 days after the operation.