Resistance to non-depolarizing neuromuscular blocking agents

The authors experienced three cases of the resistance to the nondepolarizing neuromuscular blocking agents (NMBAs), rocuronium. There are many factors that affect NMBAs such as steroid, endocrine or autoimmune diseases which are thyroid disease, parathyroid disease, myasthenia gravis and etc., and anticonvulsant medication. However, in these three cases, the patients did not have any neuromuscular disorder, except certain drug administration, smoking, endocrine disorder and fever. In this study, we report three cases of the resistance to rocuronium where the resistance duration was much shorter than known and we should be aware of the importance of neuromuscular monitoring.

[1]  M. Chung,et al.  Comparison of rocuronium-induced neuromuscular blockade in second trimester pregnant women and non-pregnant women. , 2018, International journal of obstetric anesthesia.

[2]  J. R. Ortiz-Gómez,et al.  Failure of sugammadex to reverse rocuronium-induced neuromuscular blockade: a case report. , 2014, European journal of anaesthesiology.

[3]  S. Soltész,et al.  Dexamethasone decreases the duration of rocuronium-induced neuromuscular block: A randomised controlled study , 2014, European journal of anaesthesiology.

[4]  Y. Shin,et al.  The effect of phenylephrine on the onset time of rocuronium , 2010, Korean journal of anesthesiology.

[5]  A. Duman,et al.  The statistical power in the study of onset and duration of rocuronium in hyperthyroidism and euthyroidism patients. , 2009, Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques.

[6]  J. Martyn,et al.  Systemic Inflammation Leads to Resistance to Atracurium without Increasing Membrane Expression of Acetylcholine Receptors , 2003, Anesthesiology.

[7]  D. Greenblatt,et al.  Pharmacokinetics and pharmacodynamics of vecuronium in children receiving phenytoin or carbamazepine for chronic anticonvulsant therapy. , 2001, British journal of anaesthesia.

[8]  E. Olofsen,et al.  Recirculatory Pharmacokinetics and Pharmacodynamics of Rocuronium in Patients: The Influence of Cardiac Output , 2001, Anesthesiology.

[9]  T. Heier,et al.  Temperature-dependent Pharmacokinetics and Pharmacodynamics of Vecuronium , 2000, Anesthesiology.

[10]  Hossein Afarideh,et al.  Journal of Pharmacy & Pharmaceutical Sciences A Publication of the Canadian Society for Pharmaceutical Sciences Société canadienne des sciences pharmaceutiques , 2000 .

[11]  A. Yli-Hankala,et al.  Effect of smoking on dose requirements for vecuronium. , 1996, British journal of anaesthesia.

[12]  C. Meistelman,et al.  Comparison of Twitch Depression of the Adductor Pollicis and the Respiratory Muscles Pharmacodynamic Modeling without Plasma Concentrations , 1994, Anesthesiology.

[13]  Ronald D. Miller,et al.  Comparison of Rocuronium, Succinylcholine, and Vecuronium for Rapid‐sequence Induction of Anesthesia in Adult Patients , 1993, Anesthesiology.

[14]  F. Fiacchino.  Regulation of skeletal muscle acetylcholine receptors. , 1993, Anesthesiology.

[15]  R. S. Jaffe,et al.  Up‐and-down Regulation of Skeletal Muscle Acetylcholine Receptors Effects on Neuromuscular Blockers , 1992, Anesthesiology.

[16]  T. Heier,et al.  Mild intraoperative hypothermia increases duration of action and spontaneous recovery of vecuronium blockade during nitrous oxide-isoflurane anesthesia in humans. , 1991, Anesthesiology.

[17]  J. Hunter.  Resistance to non-depolarizing neuromuscular blocking agents. , 1991, British journal of anaesthesia.