ABSTRACT
We describe a case of prolonged neuromuscular block (longer than 8 hours) after administration of mivacurium. The patient was shown to be homozygous for the atypical butyrylcholinesterase gene. We discuss our treatment of the patient as well as other cases described in the literature, emphasizing the need for neuromuscular monitoring.
Subject(s)
Anesthesia Recovery Period , Isoquinolines/adverse effects , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents/adverse effects , Aged , Butyrylcholinesterase/genetics , Homozygote , Humans , Male , Mivacurium , Time FactorsABSTRACT
In a sample of 20 healthy men (ASA I) we studied the thermal effects induced after epidural anesthetic blockade with bupivacaine (0.625%) and their relationship with the level of sensitive blockade to puncture or to cold. After 30 min of epidural injection of bupivacaine the level of cephalic analgesia was D IX (D IX +/- 2 segments) and that of cold discrimination D VII (D VII +/- 2 segments) being the thermo-algesic differential blockade of 2 to 3 segments. During epidural anesthesia there was a significant increase in foot skin temperature (4.1 +/- 1 centigrade degrees, p less than 0.001) without any appreciable skin temperature change at the thorax, abdomen, thigh, and calves. It is concluded that epidural anesthesia with bupivacaine (0.625%) at a sensitive analgesic level D IX produces significant increases in skin temperature only at the foot. This indicates that the extension level of sympathetic blockade is lower that of the analgesia.
