Abstract
Purpose
To report a case of reduced duration of action of rocuronium in a patient with normocalcemic hyperparathyroid ism (HPT).
Clinical features
A 56-yr-old patient with primary HPT, who had had surgical resection of three and a half parathyroid glands nine months previously, was referred to our institution for further investigation of a persistent increase in parathyroid hormone. Preoperatively, the patient had a normal serum ionized and total calcium. The patient was diagnosed with a persistent parathyroid adenoma and was scheduled for an elective parathyroidectomy.
General anesthesia was induced with iv propofol, fentanyl and succinylcholine. Intraoperatively, anesthesia was maintained with nitrous oxide in oxygen, and isoflurane. Neuromuscular blockade was attained using incremental doses of rocuronium. The average duration of 0.15 mg·kg−1 incremental doses of rocuronium was 5.9 min (expected: 13–18 min), and that of 0.2 mg·kg−1 was ten minutes (expected: 19–23 min).
Conclusion
Primary HPT even in the absence of hypercalcemia may result in resistance to competitive blockade by rocuronium. It suggests that primary HPT may cause acetylcholine receptor upregulation resulting in hyposensitivity to non-depolarizing muscle relaxants.
Résumé
Objectif
Présenter un cas de réduction du temps d’action du rocuronium chez un patient atteint d’hyperparathyroïdie (HPT) normocalcémique.
Éléments cliniques
Un patient de 56 ans, atteint d’HPT primaire, avait subi, neuf mois auparavant, la résection chirurgicale de trois glandes parathyroïdes et demie et avait été dirigé vers notre institution pour une investigation plus poussée de l’augmentation persistante de l’hormone parathyroïde. Avant l’opération, le patient avait un niveau de calcium total et ionisé normal. Le diagnostic d’adénome parathyroïde persistant a été établi et une parathyroïdectomie a été planifiée. L’anesthésie générale a été induite avec des agents iv, propofol, fentanyl et succinylcholine. Pendant l’opération, l’anesthésie a été maintenue avec du protoxyde d’azote dans de l’oxygène, et de l’isoflurane. Le blocage neuromusculaire a été obtenu par des doses progressives de rocuronium. La durée moyenne des doses progressives de 0,15 mg·kg−1 a été de 5,9 min (normale : 13–18 min), et celle des doses de 0,2 mg·kg−1 a été de 10 min (normale : 19–23 min).
Conclusion
L’HPT primaire, même sans hypercalcémie, peut provoquer une résistance au blocage compétitif du rocuronium. Ce qui suggère que l’HPT primaire puisse causer une régulation positive du récepteur d’acétylcholine menant à une hyposensibilité aux myorelaxants non dépolarisants.
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Munir, M.A., Jaffar, M., Arshad, M. et al. Reduced duration of muscle relaxation with rocuronium in a normocalcemic hyperparathyroid patient. Can J Anesth 50, 558–561 (2003). https://doi.org/10.1007/BF03018640
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DOI: https://doi.org/10.1007/BF03018640