O'Connell Matthew P, Stauber Sierra D
Department of Pharmacy (MO), Yale New Haven Hospital, New Haven, CT.
Department of Pharmacy (SS), University of Rochester Medical Center, Rochester, NY.
J Pediatr Pharmacol Ther. 2022;27(4):400-403. doi: 10.5863/1551-6776-27.4.400. Epub 2022 May 9.
Neuromuscular blockade may be required in critically ill pediatric patients to facilitate ventilator synchrony or maintain safety during high-risk procedures. Vecuronium is one neuromuscular blocking agent used for this purpose; however, there are limited data regarding its use in pediatric patients with renal failure. Although predominantly considered to be metabolized by the liver, there are numerous adult cases and 1 pediatric case report that have described extended paralysis from vecuronium due to renal failure. The proposed mechanism is accumulation of renally cleared active metabolites. This case report describes an infant with vecuronium exposure during continuous renal replacement therapy who experienced prolonged neuromuscular blockade for several days after the agent was stopped. This highlights the importance of considering renal function when selecting neuromuscular blocking agent.
危重症儿科患者可能需要使用神经肌肉阻滞剂，以促进呼吸机同步或在高风险手术期间维持安全。维库溴铵是用于此目的的一种神经肌肉阻滞剂；然而，关于其在肾衰竭儿科患者中的使用数据有限。尽管主要认为维库溴铵由肝脏代谢，但有许多成人病例和1例儿科病例报告描述了因肾衰竭导致维库溴铵引起的长时间麻痹。推测的机制是经肾脏清除的活性代谢产物蓄积。本病例报告描述了一名在持续肾脏替代治疗期间接触维库溴铵的婴儿，在该药物停用后经历了数天的长时间神经肌肉阻滞。这突出了在选择神经肌肉阻滞剂时考虑肾功能的重要性。
