Viggiano M, Soler C, Dumont J C, Pellissier D, François G
Département d'Anesthésie-Réanimation, C.H.U. Timone, Marseille.
Ann Fr Anesth Reanim. 1995;14(6):502-4. doi: 10.1016/s0750-7658(05)80491-5.
Mivacurium, a new short acting non depolarizing neuromuscular blocker, is metabolized, as suxamethonium, by plasma cholinesterase. Therefore its duration of action is increased in patients with reduced plasma cholinesterase activity. We report a case of prolonged neuromuscular block after an i.v. bolus of mivacurium (0.20 mg.kg-1) in a 69 year-old ASA II woman with an unrecognized cholinesterase deficiency undergoing a lumbar sympathectomy for arteriopathy of the lower limbs. The duration of the block was 6 h and plasma cholinesterase concentrations were very low (540 and 610 UI.L-1), as well as the dibucaine number (16%), which suggests an homozygous enzymatic deficiency. Mechanical ventilation and sedation were continued until spontaneous return of full neuromuscular function.
米库氯铵是一种新型短效非去极化神经肌肉阻滞剂，与琥珀胆碱一样，由血浆胆碱酯酶代谢。因此，在血浆胆碱酯酶活性降低的患者中，其作用持续时间会延长。我们报告了一例69岁、ASA II级的女性患者，因下肢动脉病变接受腰交感神经切除术，静脉注射米库氯铵（0.20 mg·kg-1）后出现神经肌肉阻滞延长的病例。该患者的阻滞持续时间为6小时，血浆胆碱酯酶浓度非常低（540和610 UI·L-1），地布卡因值也很低（16%），提示存在纯合酶缺乏。持续进行机械通气和镇静，直至神经肌肉功能完全自发恢复。
