Abstract
In a retrospective one-year study, we documented respiratory failure or prolonged neuromuscular blockade in eight of 65 patients with chronic renal failure who had received either vecuronium (four of 29 patients) or atracurium (four of 36 patients) during anaesthesia for kidney transplantation. We reviewed the charts of the patients and recorded all aspects of medication and anaesthesia to try to determine whether there might be a single factor associated with this high incidence (12 per cent) of respiratory failure. Anaesthesia for all patients was induced with thiopentone, isoflurane, and N2O/O2. Tracheal intubation was facilitated with muscle relaxants in a single bolus of vecuronium, 0.07 to O.1 mg · kg−1, or atracurium, 0.3 to 0.5 mg · kg−1. Additional doses were given according to neuromuscular activity, which was monitored visually by response to train-of-four and tetanic stimulation. Anaesthesia was maintained with fentanyllisoflurane and N2O/O2. After induction of anaesthesia, each patient received methylprednisolone, cefazolin, mannitol infusion for 24 hr beginning at the start of renal artery anastomosis, and either azathioprine (n = 57) or cyclosporine (n = 8). Relaxation was evaluated toward the end of the operation by train-of-four stimulation. Neuromuscular blockade was reversed with edrophonium (0.75-1 mg · kg−1) or neostigmine (0.06–0.08 mg · kg−1). The eight patients with prolonged neuromuscular blockade received ventilatory support for one to three hours after operation. Respiratory failure was significantly more frequent inpatients who received cyclosporine (P < 0.05).
Résumé
En un an, quatre des 36 patients qui avaient reçu de l’atracurium et quatre des 29 autres qui avaient eu du vécuronium lors de leur transplantation rénale ont été affligés d’un bloc neuromusculaire prolongé ou d’un épisode de défaillance respiratoire. L’induction de l’anesthésie avec du thiopental, de isoflurane et du protoxyde d’azote précédait l’injection d’un bolus de 0,07 à 0,1 mg · kg−1 de vécuronium ou de 0,3 à 0,5 mg · kg−1 d’atracurium avant l’intubation de la trachee. L’évaluation visuelle de la réponse neuromusculaire au train-de-quatre ondes ou la stimulation tétanique guidait l’énjection de doses additionnelles alors quon ajoutait du fentanyl au régime d’isoflurane et de protoxyde d’azote. Après l’induction, on injectait en plus de la méthylprednisolone, de la céfazoline et du mannitol (perfusé pendant 24 h suite à l’anastomose de l’artére rénale) soit de l’azathioprine (n = 57) soit de la cyclosporine (n = 8). A la fin de l’intervention, on contrail le bloc neuromusculaire résiduel (évalué avec le train-de-quatre ondes) avec 0,75 à 1 mg · kg−1 avec 0,06 à 0,08 mg · kg−1 de néostigmine. On dut supporter mécaniquement la ventilation des huit patients au bloc neuromusculaire persistant pour une période d’une à trois heures. En retrospective, ces épisodes de défaillance respiratoire survenaient de préférence chez ceux qui avaient reçu de la cyclosporine (P < 0,05).
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Sidi, A., Kaplan, R.F. & Davis, R.F. Prolonged neuromuscular blockade and ventilatory failure after renal transplantation and cyclosporine. Can J Anaesth 37, 543–548 (1990). https://doi.org/10.1007/BF03006323
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DOI: https://doi.org/10.1007/BF03006323