Prolongation of neuromuscular blocking effect of vecuronium by antibiotics

Abstract

SummaryA case is described of prolonged neuromuscular block in a patient who was given the muscle relaxant vecwonium ,fbllowed by bolus injections of' the antibiotics gentamycin and clindamycin. Key wordsAntibiotics; gentamycin, clindamycin. Complications; prolonged neuromuscular blockadeVecuronium is an intermediate acting, nondepolarising muscle relaxant. Time for full recovery of muscle action following a single dose of vecuronium (which produces 90% depression of muscle contraction) is approximately onethird of that after an equipotent dose of pancuronium.',2 However, the duration of neuromuscular block following an exaggerated high dose of 0.2 mg/kg is not more than 120 minutes.j We report a case of prolonged neuromuscular block thought to be due to interaction between vecuronium and the antibiotics gentamycin and clindamycin. Case historyA 52-yedr-old female with a history of hypertension and congestive heart failure controlled with digoxin 0.25 mg/day, nifedipine 20 mg/day and frusemidc 40 mg biweekly, presented for elective removal of a carcinoma of the colon. Her general condition before surgery was stable, she was not in heart failure and her arterial blood pressure was 170190 mmHg. Liver function was normal, as were her serum electrolytes and acid-basc status. Premedication was with oral diazepam 10 mg. 2 hours before surgery, and pcthidinc SO mg and promethazine 25 mg intramuscularly one hour before surgery. Anaesthesia was induced with intravenous midazolani 9 mg, fentanyl 0.05 mg and lignocaine 100 mg and the trachea intubated after 75 mg suxamethonium. After recovery from the suxamethonium. vecuronium 0.08 mg/kg (4 mgj was injected intravenously. Monitoring of neuromuscular block was by continuous recording of the train-of-four (TOFj using ulnar nerve stimulation. Ten minutes after the vecuronium was given, gentamycin I20 mg and clindamycin 1200 mg were given as a bolus. Maintenance of anaesthesia was with 50% nitrous oxide in oxygen and fentanyl 0.3 mg in dividcd doses. Marked neuromuscular blockade was still present 160 minutes after the initial injection of vecuronium

Calcium and neostigmine antagonize gentamicin, but augment clindamycin-induced tetanic fade in rat phrenic nerve-hemidiaphragm preparations

“…Clindamycin alone induces profound, long-lasting neuromuscular blockade [13,14] and prolongs the blockade of nondepolarizing muscle relaxants [15][16][17][18].…”

Anesthesia for craniotomy in a patient with previous paralytic polio

“…However, his neuromuscular response to TOF and double-burst stimulation (ie, absence of fade) did not correlate with his clinical state. This muscle weakness might have been aggravated by amikacin, which is an aminoglycoside antibiotic [7,8]. Aminoglycoside antibiotics can cause weakness, even in the absence of neuromuscular blocking agents [4].…”

The synergistic effect of gentamicin and clindamycin on rocuronium-induced neuromuscular blockade

“…As the results of this study demonstrate, neuromuscular blocking effects may be induced even at commonly used doses because of the synergistic interactions. In point of case, there have been reports indicating that the effect of vecuronium was prolonged in patients treated with gentamicin and clindamycin at clinical doses [13]. …”

“…Because these two drugs have different mechanisms of neuromuscular blockade, they may synergistically interact to reduce the effective concentrations of each. It has been reported that the recovery of muscle relaxation was delayed in patients who were administered with vecuronium and then treated with two antibiotics [13]. However, analysis of the interaction between antibiotics and muscle relaxants is rare.…”