Mivacurium chloride
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Mivacurium chloride Prolonged paralysis in an infant with Bamforth syndrome: case report A 3-month-old female infant developed prolonged paralysis during treatment with mivacurium chloride to facilitate tracheal intubation during gastrostomy. The infant, who had dysmorphic features and congenital hypothyroidism that had been diagnosed as Bamforth syndrome, received IV mivacurium 0.15 mg/kg. After surgery was completed, for 30 minutes, her recovery was slower than expected [time to reaction onset not stated]. She continued to receive mechanical ventilation and sedation until she spontaneously recovered full neuromuscular function. The infant received IV atropine and neostigmine to reverse muscle relaxation. Three hours after she received mivacurium, she exhibited signs of spontaneous respiration. One hour later, she was extubated, and she recovered fully. She was transferred to recovery for continuous monitoring. After the operation, her plasma cholinesterase activity was found to be 408 IU/L (normal 5400–13 200). Author comment: "Deficiency or abnormality of plasma cholinesterase . . . may cause the duration of action of mivacurium to be greatly prolonged. . . Our patient with Bamforth syndrome experienced prolonged paralysis [after a single mivacurium dose] because of a major [plasma cholinesterase] deficiency." Yildiz TS, et al. Unexpected prolonged paralysis after mivacurium in a patient with Bamforth syndrome. Pediatric Anesthesia 16: 892-894, No. 8, Aug 2006 801044234 Turkey
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Reactions 9 Sep 2006 No. 1118
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