Prolonged effect of succinylcholine after neostigmine and pyridostigmine administration in patients with renal failure

Abstract

The authors report two cases of prolonged succinylcholine neuromuscular blockade in patients with renal failure, each of which occurred when the drug was administered several hours after the end of a kidney transplantation. We feel these prolonged blockades can be explained by altered anticholinesterase kinetics, although lower than normal pseudocholinesterase levels also have contributed. That prolonged blockade has not been reported previously in this circumstance is explained by the rare occurrence of a combination of events; the patient with renal failure who has received an anticholinesterase and is administered succinylcholine several hours later. Based on this experience and review of the pertinent literature, when these three conditions are present, prolonged succinylcholine blockade probably is the rule rather than the exception.