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Canadian Journal of Anaesthesia

, Volume 42, Issue 7, pp 614–617 | Cite as

Clindamycin-induced neuromuscular blockade

  • Osama Al Ahdal
  • David R. Bevan
Clinical Reports

Abstract

The purpose of this article is to report the case of a patient who developed prolonged neuromuscular block after a large dose of clindamycin (2400 mg). A 58-yr-old, 65 kg woman with severe rheumatoid arthritis was admitted for wrist arthrodesis. After d-tubocurarine (3 mg) and fentanyl (1.5 μg · kg−1), anaesthesia was indúced with thiopentone (4 mg · kg−1) followed by succinycholine (1.5 mg · kg−1) and was maintained with N2O in O2 and isoflurane (0.75-1.0% end tidal) and ventilation was controlled. No further neuromuscular relaxants were given although full return of neuromuscular activity in response to train-of-four and 100 Hz tetanic stimulation was observed after succinylcholine. An overdose of clindamycin (2400 mg, instead of the intended 600 mg) was given iv soon after the start of surgery. At the end of surgery, 75 min later, the patient made no attempt at spontaneous ventilation, was unresponsive to painful stimuli and naloxone (0.2 mg iv) was ineffective. Controlled ventilation was continued in the Recovery Room where neuromuscular testing showed a train-of-four ratio of 0.27 which improved to only 0.47 five minutes after calcium chloride (1.5 mg · kg−1 iv), and to 0.62 after edrophonium (20 mg) and neostigmine (2 mg). Nine hours later the patient began to cough, the TOF had returned to 1.0 and two hours later the trachea was extubated and spontaneous ventilation was resumed. Large doses of clindamycin can induce profound, long-lasting neuromuscular blockade in the absence of non-depolarizing relaxants and after full recovery from succinylcholine has been demonstrated.

Key words

antibiotics: clindamycin complications: drug overdose, paralysis neuromuscular function: antibiotics pharmacology: drug interactions 

Résumé

Cette observation décrit une curarisation prolongée provoquée par une dose exagérée de clindamycine (2400 mg). Une femme de 58 ans pesant 65 kg affectée d’une arthrite rhumatoïde grave est programmée pour une arthrodèse du poignet. Après dtubocurarine 3 mg et fentanyl 1,5 μg · kg−1, l’anesthésie est induite avec du thiopentone 4 mg · kg−1 suivi de succinylchlone 1,5 mg · kg−1 et entretenue avec N2O/O2 et isoflurane à la concentration téléexpiratoire de 0,75-1,0% en ventilation contrôlée. Elle ne reçoit pas de supplément de myorelaxant quoique la récupération complète de la succinylcholine évaluée par la stimulation au train de quatre (TOF) et au tétanos à 100 Hz soit évidente. Une dose exagérée de clindamycine (2400 mg plutôt que les 600 mg prévus) avait été administrée dès le début de l’intervention. A la fin de la chirurgie, 75 min plus tard, la patiente ne fait aucun effort respiratoire, ne répond ni au stimulus douloureux ni au naloxone 0,2 mg iv. La ventilation contrôlée est continuée en salle de réveil où la stimulation produit un TOF à 0,27 qui ne remonte qu’ 0,47% cinq minutes après du chlorure de calcium 1,5 mg · kg−1, et à 0,62 après de l’édrophonium 20 mg et de la néostigmine 2 mg. Neuf heures plus tard, la patiente commence à tousser, le TOF revient à 1,0 et deux heures plus tard la ventilation spontanée récupère et la trachée est extubée. Des doses élevées de clindamycine peuvent provoquer une curarisation profonde et de longue durée indépendante des non dépolarisants et après que la récupération complète de la succinylcholine ait été démontrée.

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Copyright information

© Canadian Anesthesiologists 1995

Authors and Affiliations

  • Osama Al Ahdal
    • 1
  • David R. Bevan
    • 1
  1. 1.Department of AnaesthesiaVancouver Hospital and UBCVancouver

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