Vigouroux D, Voltaire L
Service d'Anesthésie Urgences et Réanimation, CHR Rangueil, Toulouse.
Ann Fr Anesth Reanim. 1995;14(6):508-10. doi: 10.1016/s0750-7658(05)80493-9.
A case is reported of prolonged neuromuscular block after mivacurium chloride for laparoscopic cholecystectomy, in a 45 years old patient, treated with cyclophosphamide for a Wegener's granulomatosis. The neuromuscular function monitoring by train-of-four showed a duration of action of 75 min after an intubation dose of 0.20 mg.kg-1. Additional bolus of 1 mg, corresponding to 25% of usual doses, every 10 or 15 min, were sufficient for maintaining muscle relaxation. Spontaneous recovery, without any antagonization, lasted 40 min for a TOF ratio (T4/T1) > or = 70%. Recovery index from 25 to 75% were 13 min. Plasma butyrilcholinesterases activity were reduced to a level of 50%. With reference to literature about succinylcholine, the responsibility of cyclophosphamide is likely, and discussed. This observation shows the value of monitoring the neuromuscular transmission.
报道了1例45岁因韦格纳肉芽肿接受环磷酰胺治疗的患者，在腹腔镜胆囊切除术中使用氯米库铵后出现长时间神经肌肉阻滞的病例。四次成串刺激法监测神经肌肉功能显示，插管剂量为0.20mg/kg后作用持续时间为75分钟。每10或15分钟追加1mg（相当于常用剂量的25%）足以维持肌肉松弛。自发恢复，未进行任何拮抗，TOF比值（T4/T1）≥70%时持续40分钟。从25%恢复到75%的恢复指数为13分钟。血浆丁酰胆碱酯酶活性降至50%的水平。参考有关琥珀酰胆碱的文献，环磷酰胺的作用可能很大，并对此进行了讨论。该观察结果显示了监测神经肌肉传递的价值。
