To the Editor, We read with great interest the case report by Moriwaki and Kayashima [1] in the journal. The authors described the patient demonstrating prolonged neuromuscular blockade even after administration of sugammadex considered as appropriate for reversal of rocuronium. After the surgery, the long-lasting residual blockade was antagonized by supplemental administration of neostigmine and atropine, and the patient's trachea was extubated without any complications. Although the course and the explanation were acceptable , we have several concerns for the case. First, the authors administered neostigmine and atro-pine. The reversal temporally increased the train of four ratio; however, no one can predict the duration of prolonging blockade and the half time of neostigmine is approximately 1 h. The patient showed the apparent residual blockade even after 163 min from the induction of anesthesia. More length of time might be required for the complete recovery [2]. Intensive care and careful observation would be appreciated. Second, the authors emphasized the effect of magnesium and calcium-antagonists on acetylcholine release. The combination is well known for the treatment of cholinergic crisis in the area of toxicology [3]. The non-depolarizing neuromuscular blocking agents have presynaptic inhibitory effect on neuronal acetylcholine receptors [4]. The residual blockade might be so complicated and there was a room for discussion. We previously reported the case of a patient developing recurarization after administration of sugammadex following a prolonged rocuronium infusion [5]. In the case, unexpected decrease of elimination of rocuronium by hypothermia might be a factor of the recurarization. The cause of unexpected prolongation and residual of neuro-muscular blockade varies [6, 7]. Residual neuromuscular blockade absolutely could not be overlooked after anesthesia [8]. Anesthesiologists should pay more attention to prolonged neuromuscular blockade. Acknowledgements Not applicable.
CITATION STYLE
Higashi, M., Tamura, T., & Adachi, Y. U. (2019). Prolonged neuromuscular blockade by non-depolarizing neuromuscular blocking agents. JA Clinical Reports, 5(1). https://doi.org/10.1186/s40981-019-0253-y
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