Prolonged paralysis related to mivacurium: A case study

Kendrick, Kathy

doi:10.1016/j.jopan.2004.11.006

Cited by 8 publications

(11 citation statements)

References 27 publications

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“…However, if prolonged paralysis does occur, the patient is usually admitted to the ICU for extended intubation and mechanical ventilation. [1][2][3][4][5][6] Succinylcholine and mivacurium are NMBAs of choice when only a very short period of paralysis is needed. Recovery from succinylcholine paralysis starts within 2 to 3 minutes, and recovery from mivacurium paralysis begins within approximately 5 to 10 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9]18 Nurses should recognize and report an abnormal dibucaine inhibition number and plasma cholinesterase levels. Additionally, nurses should not hesitate to discuss referral for genetic consultation when the dibucaine inhibition number is less than 80%.…”

Section: Nursing Skill Rationalementioning

confidence: 99%

“…Furthermore, residual blockade may be only several hours long, and exposure of patients to muscarinic side effects of increased acetylcholine levels such as bradycardia, excessive oral and pulmonary secretions, and vomiting may not be warranted. 1,5,16 Use of fresh frozen plasma to reverse paralysis is questionable because the reversal from the small amount of plasma cholinesterase contained in fresh frozen plasma is usually transient and multiple units may be required to keep the paralysis adequately reversed.2 Whether or not reversal of paralysis is attempted, the primary plan of • Drug blocks the acetylcholine receptor and prevents binding to the postsynaptic acetylcholine receptor. Drug prevents depolarization of plasma membrane of motor end plate and muscle contraction.…”

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confidence: 99%

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Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

Jaramillo

Scruth

Cheng

2009

American Journal of Critical Care

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After receiving mivacurium, a short-acting neuromuscular blocking agent used for intubation before surgery, a patient experienced prolonged paralysis and prolonged apnea that required ventilator support. Although this complication is rare, all critical care nurses should be aware of it so they can be competent in managing and providing holistic and comprehensive nursing care to the patient and the patient's family. Although this complication has been documented in the anesthesia literature, it has received little mention in critical care nursing journals. (American Journal of Critical Care. 2009;18:592,588-591) T his case report describes a patient who had prolonged paralysis and apnea after receiving mivacurium, a neuromuscular blocking agent (NMBA), for endotracheal intubation before surgery. This rare perioperative complication occurs in patients with plasma cholinesterase (pseudocholinesterase) deficiency. Most reported cases of prolonged paralysis are in patients receiving succinylcholine. In this case report, we discuss the use of both depolarizing and nondepolarizing muscle relaxants that undergo metabolism by plasma cholinesterase and the following critical care nursing issues: providing competent care for patients receiving NMBAs, management of acute prolonged paralysis and apnea, management of suspected plasma cholinesterase deficiency, strategies for prevention and patient safety, and future objectives for research. Case ReportA 56-year-old woman with a below-the-knee amputation of the right lower extremity was readmitted to the hospital for treatment of a 1-week-old stump that was dehisced and infected due to injury. Her medical history included chronic kidney disease treated with peritoneal dialysis, congestive heart failure, hypertension, neuropathy, peripheral vascular disease, diabetes, and malnourishment. The plan Continued on page 588Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient's experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org. After induction and the start of maintenance anesthesia, the train of four (TOF) delivered by the peripheral nerve stimulator was 0 out of 4 twitches, indicating complete paralysis or 100% blockage of the acetylcholine receptors at the motor end plate. Because the patient's TOF did not return as expected and neuromuscular blockade could not be reversed, the surgical procedure was deferred and the patient was transferred to the intensive care unit (ICU) still intubated and mechanically ventilated for recovery from anesthesia. The prolonged paralysis was assumed to be due to plasma cholinesterase deficiency that resulted in extremely slow metabolism of mivacurium. By day 3, the patient's paralysis had compl...

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Section: Discussionmentioning

confidence: 99%

Section: Nursing Skill Rationalementioning

confidence: 99%

mentioning

confidence: 99%

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Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

Jaramillo

Scruth

Cheng

2009

American Journal of Critical Care

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“…With normal levels of pseudocholinesterase, succinylcholineinduced neuromuscular blockade should only last 10 to 12 minutes. 1,2,6,7 Persons with a deficiency of pseudocholinesterase or those with an inherited atypical variation of this enzyme may have delayed recovery from muscle paralysis that results after the administration of succinylcholine. Mivacurium, like succinylcholine, is rapidly hydrolyzed in the plasma by pseudocholinesterase; therefore, patients with pseudocholinesterase deficiency may have prolonged paralysis related to either drug.…”

Section: Pseudocholinesterase Insufficiencymentioning

confidence: 99%

A Case of Pseudocholinesterase Deficiency in the PACU

Leadingham¹

2007

Journal of PeriAnesthesia Nursing

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“…However, the 102 gotras of Gavara's separated out, and formed the Gavara Komati community. [7,8] Pseudocholinesterase: It was reported that, cholinesterase was of 2 types, one is acetylcholinesterase and another one is pseudocholinesterase. Acetylcholinesterases inactivates acetylcholine produced at the neuromuscular junction during neurotransmission whereas pseudocholinesterase, a glycoprotein enzyme having complex molecular structure synthesized in the liver and immediately released into the plasma with a half-life of 12 days [9,10] also found in many tissues with the exception of red blood cells, and its function is unknown, it has been suggested that it may specifically hydrolyze certain exogenous cholinesters which inhibit acetylcholinesterase.…”

Section: Introductionmentioning

confidence: 99%

Pseudocholinesterase Deficiency in an Indian Community

Maddi¹,

Prudhivi²

2017

JPPCM

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Back ground: India, the seventh largest country, 3rd largest standing army and one of the oldest civilizations in the world, with a literacy rate of 74.04%. Indian population was a mixture of 46,73,034 categories of different castes and sub-caste each related to a specific occupation. Arya Vysya is a Hindu Indian caste with a total population of 22,952,000. Methods:Pseudocholinesterase is a glycoprotein enzyme with complex molecular structure synthesized in the liver and specifically hydrolyzes certain exogenous cholinesters. Pseudocholinesterase deficiency is a genetic enzyme abnormality or acquired alteration in the metabolism of choline esters in this patient may experience a paralysis of the respiratory muscles, to overcome this, required more time mechanically-assisted breathing. The presence of the genetic defect is not realized until one is exposed to succinylcholine or mivacurium. Results: Arya Vysya community people of India having deficiency of pseudocholinesterase is the most affected people than any other with homozygous mutation incidence rate of 2-4%. Very recent studies in 2016 reveal that malnutrition-induced pseudocholinesterase deficiency is also a possible etiology. Conclusion: It was suggested that the Arya Vysya Community people with a history of pseudocholinesterase deficiency should tell his or her doctor if when they undergo anesthesia for surgery to avoid potentially serious unwanted adverse effects.

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Prolonged paralysis related to mivacurium: A case study

Cited by 8 publications

References 27 publications

Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

Prolonged Paralysis and Apnea After Receiving a Neuromuscular Blocking Agent: What Nurses Should Know

A Case of Pseudocholinesterase Deficiency in the PACU

Pseudocholinesterase Deficiency in an Indian Community

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