Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery

A, Bhardwaj; Dharmavaram, Sudhindra; Wadhawan, Sonia; Sethi, Anjali; Bhadoria, Poonam

doi:10.4103/0970-9185.81833

Cited by 10 publications

(7 citation statements)

References 3 publications

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“…It has a half-life of approximately 72 h, and requires 2–3 weeks for complete wash out [59]. Published case reports demonstrate that patients on donepezil may exhibit high intraoperative requirements for non-depolarizing neuromuscular blockers including atracurium, rocuronium, and vecuronium [57, 60]. In contrast, prolonged paralysis has been described with administration of succinylcholine to a patient on donepezil, potentially due to reduced pseudocholinesterase inhibitor activity [58].…”

Section: Main Bodymentioning

confidence: 99%

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

2019

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Background: The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction. Main body: This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer's disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment. Conclusions: Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.

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Section: Main Bodymentioning

confidence: 99%

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

2019

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“…Baruah et al [ 2 ] reported that four twitches were continuously observed in response to TOF stimulation after the administration of a single intubating dose of atracurium 30 mg and a supplemental dose of 10 mg in an Alzheimer’s disease patient who had been taking donepezil for 14 mo. Bhardwaj et al [ 3 ] reported the case of an Alzheimer’s disease patient who had been taking donepezil (5 mg daily) for 4 mo. Spontaneous respiratory efforts reappeared while attempting intubation after the administration of a single intubation dose of rocuronium 0.6 mg/kg, and repeated administrations of rocuronium and vecuronium could not inhibit the return of spontaneous respiratory efforts.…”

Section: Discussionmentioning

confidence: 99%

Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report

Jang

Kim

Jung

et al. 2020

WJCC

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BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels. This drug may potentially interact with neuromuscular blocking agents (NMBAs) that act on muscular acetylcholine receptors during general anesthesia. Herein, we present a case of inadequate neuromuscular blockade with rocuronium, a nondepolarizing NMBA, in a dementia patient who had taken donepezil. CASE SUMMARY A 71-year-old man was scheduled for laparoscopic gastrectomy. He had been taking donepezil 5 mg for dementia. General anesthesia was induced with propofol and remifentanil. The depth of neuromuscular blockade was monitored by train-of-four (TOF) stimulation. After the administration of rocuronium, the TOF ratio decreased at an unusually slow rate, and a TOF count of 0 was detected 7 min later. After intubation, a TOF count of 1 was detected within 1 min, and a TOF ratio of 12% was detected within 2 min. The TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium, suggesting resistance to this NMBA. Instead of propofol, an inhalation anesthetic was administered alongside another NMBA (cisatracurium). Then, the quality of neuromuscular blockade improved, and the TOF count remained at 0-1 for the next 70 min. No further problems were encountered with respect to surgery or anesthesia. CONCLUSION Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia, especially when total intravenous anesthesia is used.

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“…In the Japanese Multi-Institutional Collaborative Cohort ( n = 697, 35–69 years old), adiponectin levels were associated with consumption of bread and dairy products, and low intake of rice, and inversely correlated with waist circumference and insulin resistance, as estimated using the homeostasis model assessment (HOMA-IR) [ 159 ]. Another possibility is concurrent modifications of energy metabolism and muscle tone, because of the presence of atypical parkinsonian symptoms or cases among dementia patients [ 160 ], as well as the administration of acetylcholinesterase inhibitors (ACHEIs) [ 161 ]. Donepezil has been shown to attenuate muscle atrophy and induce neovascularization in vitro and in a murine hind limb ischemia model [ 162 ], and enhance neuronal mitochondrial biogenesis and oxidative phosphorylation in vitro and ex vivo [ 163 ], while it up-regulated adiponectin over leptin synthesis, towards a reduction of total and abdominal fat deposition, in stage 3 to 4 AD patients, within 6 months [ 164 ].…”

Section: Energy Balance Micronutrient Deficiencies and Adipokinesmentioning

confidence: 99%

Appetite, Metabolism and Hormonal Regulation in Normal Ageing and Dementia

Nifli

2018

Diseases

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Feeding and nutrition follow the growth trajectory of the course of life. The profound physiological changes that human body experiences during ageing affect separate aspects of food intake, from tastant perception to satiety. Concurrent morbidities, such as neurodegeneration, as seen in dementia, and metabolic syndrome, may further shape nutritional behaviours, status and adequacy. In an effort to fill the gap between the exhausting basic research and the actual needs of professionals caring for the exponentially expanding ageing population, the current review addresses major factors relevant to appetite and eating disturbances. Does age alter the perception of food modalities? Is food generally still perceived as alluring and delicious with age? Is there an interplay between ageing, cognitive decline, and malnutrition? What tools can we adopt for proper and timely monitoring? Finally, what anatomical and pathophysiological evidence exists to support a hypothesis of central regulation of metabolic perturbations in normal and accelerated cognitive impairment, and how can we benefit from it in health practice?

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Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery

Cited by 10 publications

References 3 publications

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

Donepezil-related inadequate neuromuscular blockade during laparoscopic surgery: A case report

Appetite, Metabolism and Hormonal Regulation in Normal Ageing and Dementia

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