Kishimoto Naotaka, Yoshikawa Hiroyuki, Seo Kenji
Division of Dental Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan.
Anesth Prog. 2020 Sep 1;67(3):146-150. doi: 10.2344/anpr-66-04-04.
Lithium carbonate is a medication used for the management of various mental disorders. The present report describes a case of prolongation of rocuronium bromide in a patient concurrently taking lithium carbonate. A 64-year-old woman was scheduled to undergo cystectomy under general anesthesia. The patient took lithium carbonate (600 mg/d) for treatment of bipolar affective disorder. General anesthesia was induced with propofol, fentanyl, remifentanil, and sevoflurane. After loss of consciousness, rocuronium bromide (50 mg) was administered, and the trachea was intubated. Approximately 1 hour after the administration of rocuronium, the degree of residual muscle relaxant was evaluated using a nerve stimulation device. No muscle contraction occurred with train-of-four (TOF) stimulation. Following administration of sugammadex (200 mg) the TOF ratio increased to 95%. The ionic size of lithium is similar to that of sodium; therefore, lithium is transported into the cell with sodium. The resting membrane potential decreases, leading to a reduction in the height of the action potential. Thus, the effect of the remaining lithium may have been superimposed on the rocuronium neuromuscular blockade. Evaluation with a nerve stimulation device in patients taking lithium is crucial before extubation because of the risk of rocuronium potentiation.
碳酸锂是一种用于治疗各种精神障碍的药物。本报告描述了一例同时服用碳酸锂的患者罗库溴铵作用时间延长的病例。一名64岁女性计划在全身麻醉下接受膀胱切除术。该患者服用碳酸锂（600毫克/天）治疗双相情感障碍。采用丙泊酚、芬太尼、瑞芬太尼和七氟醚诱导全身麻醉。意识消失后，给予罗库溴铵（50毫克），并进行气管插管。给予罗库溴铵约1小时后，使用神经刺激装置评估残余肌松程度。四个成串刺激（TOF）未引起肌肉收缩。给予舒更葡糖（200毫克）后，TOF比值增至95%。锂的离子大小与钠相似；因此，锂与钠一起转运进入细胞。静息膜电位降低，导致动作电位幅度减小。因此，剩余锂的作用可能叠加在罗库溴铵的神经肌肉阻滞作用上。由于存在罗库溴铵作用增强的风险，在服用锂的患者拔管前使用神经刺激装置进行评估至关重要。
