• Br J Anaesth · Sep 1990

    Case Reports

    Prolonged paralysis following suxamethonium and the use of neostigmine.

    • M F James and H C Howe.
    • Department of Anaesthesia, Medical School, University of Cape Town, Observatory, S. Africa.
    • Br J Anaesth. 1990 Sep 1;65(3):430-2.

    AbstractA case of prolonged neuromuscular block following the administration of suxamethonium is reported. Three hours after administration of suxamethonium, a well defined, recovering phase II block was demonstrated with a T4:T1 ratio of 0.25, and neostigmine was administered. Although the T4:T1 ratio was improved to 0.9, T1 remained at 25% of control, and significant paralysis persisted which responded to administration of cholinesterase. It is concluded that neuromuscular monitoring cannot reliably predict reversibility in such cases and that, even after 3 h, antagonism of prolonged suxamethonium block should commence with cholinesterase, followed by neostigmine if necessary.

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