ACUTE QUADRIPARESIS IN AN ASTHMATIC TREATED WITH ATRACURIUM

An 18-yr-old male asthmatic was paralyzed with atracurium for a period of seven days to facilitate mechanical pulmonary ventilation. After w ithdrawal of the muscle relaxant, train-of-four neuromuscular monitori ng demonstrated rapid recovery of normal function. Three days later he developed acute quadriparesis without respiratory compromise. Electro physiological studies showed normal conduction velocities, low compoun d muscle action potential amplitudes and evidence of denervation. Most cases of post-ventilatory weakness in the ICU involve the use of vecu ronium and pancuronium. It has been suggested that the steroid nucleus in these muscle relaxants may be responsible. Our patient developed g eneralised weakness after treatment with atracurium, a benzylisoquinol inium muscle relaxant. Thus, it appears that the steroid nucleus of ve ntronium and pancuronium is not essential in causing post-ventilatory weakness.