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Der Anaesthesist

, Volume 66, Issue 6, pp 422–425 | Cite as

Laparoscopic partial nephrectomy in a patient on simvastatin

Delayed recovery from neuromuscular blockade
  • E. E. Abd El-Hakeem
  • A. M. Kaki
  • S. A. Almazlom
  • A. J. Alsayyad
Kasuistiken

Abstract

Delayed recovery from anesthesia remains a very challenging subject for anesthesiologists. This case report describes the clinical course of delayed recovery from neuromuscular blockade after laparoscopic partial nephrectomy in a patient on simvastatin. The patient was hypertensive on regular treatment with oral captopril 25 mg twice daily and amlodipine 5 mg once daily and hypercholesterolemic on regular simvastatin 40 mg once daily with a normal electrocardiogram (ECG). All preoperative laboratory findings were within normal ranges. The patient was premedicated with midazolam 1 mg and general anesthesia was induced with fentanyl 2 µg/kg body weight, propofol 2 mg/kg and rocuronium bromide 0.6 mg/kg to facilitate tracheal intubation. Anesthesia was maintained with inhalation of isoflurane 1.0–1.5 % in 40 % oxygen-enriched air and 25 µg boluses of fentanyl. The patient did not require any additional rocuronium throughout surgery which was finished after 4 h. The patient most probably had preoperative simvastatin-induced myotoxicity. This potentiated the muscle relaxant effect of rocuronium bromide and was the reason for patient unresponsiveness and delayed postoperative recovery. We can conclude that anesthesiologists should preoperatively identify statin myotoxicity and to avoid neuromuscular blocking drugs for statin-treated patients. Also, preoperative adjustment of statin dosage may be recommended.

Keywords

Delayed recovery General anesthesia Hypercholesterolemia Neuromuscular blockade Simvastatin 

Laparoskopische partielle Nephrektomie in einem Patient mit Simvastatin Behandlung

Verzögerte Regeneration von einer neuromuskulären Blockade

Zusammenfassung

Die verzögerte Regeneration nach einer Anästhesie bleibt ein schwieriges Thema für Anästhesisten. Dieser Fall beschreibt den klinischen Verlauf einer verzögerten Regeneration von einer neuromuskulären Blockade nach laparoskopischer partieller Nephrektomie bei einem Patienten, der mit Simvastatin behandelt wurde. Der Patient war hypertensiv bei einer regelmäßigen oralen Behandlung mit Captopril 25 mg 2‑mal täglich und Amlodipin 5 mg 1‑mal täglich, sowie hypercholesterolämisch bei einer regelmäßigen Behandlung mit Simvastatin 40 mg 1‑mal täglich bei normalem EKG-Befund. Alle präoperativen Laborergebnisse lagen im Normbereich. Als Prämedikation wurde dem Patienten Midazolam 1 mg verabreicht. Die Allgemeinanästhesie wurde mit Fentanyl 2 µg/kg KG, Propofol 2 mg/kg und Rocuroniumbromid 0,6 mg/kg eingeleitet, um eine tracheale Intubation zu ermöglichen. Die Anästhesie wurde durch Inhalation von Isofluran 1,0–1,5% in 40% sauerstoffangereicherter Luft und 25 µg Fentanyl als Bolus aufrechterhalten. Der Patient benötigte während des gesamten Eingriffs, der nach 4 h abgeschlossen war, kein zusätzliches Rocuronium. Bei dem Patienten lag höchstwahrscheinlich präoperativ eine Simvastatin-induzierte Myotoxizität vor. Hierdurch wurde die muskelrelaxierende Wirkung von Rocuroniumbromid potenziert, was der Grund für die Unansprechbarkeit des Patienten und die verzögerte postoperative Regeneration war. Die Autoren schließen daraus, dass Anästhesisten eine Statin-induzierte Myotoxizität präoperativ identifizieren sollten, um Medikamente, die eine neuromuskuläre Blockade bewirken, bei mit Statinen behandelten Patienten zu vermeiden. Auch eine präoperative Anpassung der Statindosis ist zu empfehlen.

Schlüsselwörter

Verzögerte Regeneration Allgemeinanästhesie Hypercholesterolämie Neuromuskuläre Blockade Simvastatin 

Notes

Compliance with ethical guidelines

Conflict of interests

E.E. Abd El-Hakeem, A.M. Kaki, S.A. Almazlom and A.J. Alsayyad declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

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Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  • E. E. Abd El-Hakeem
    • 1
  • A. M. Kaki
    • 2
  • S. A. Almazlom
    • 2
  • A. J. Alsayyad
    • 3
  1. 1.Department of Anaesthesiology, Faculty of MedicineAssiut UniversityAssiutEgypt
  2. 2.Department of Anaesthesiology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
  3. 3.Department of Urology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia

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