CLINDAMYCIN-INDUCED NEUROMUSCULAR BLOCKADE

The purpose of this article is to report the case of a patient who dev eloped prolonged neuromuscular block after a large dose of clindamycin (2400 mg). A 58-yr-old, 65 kg woman with severe rheumatoid arthritis was admitted for wrist arthrodesis. After d-tubocurarine (3 mg) and fe ntanyl (1.5 mu g . kg(-1)), anaesthesia was induced with thiopentone ( 4 mg . kg(-1)) followed by succinycholine (1.5 mg . kg(-1)) and was ma intained with N2O in O-2 and isoflurane (0.75-1.0% end tidal) and vent ilation was controlled. No further neuromuscular relaxants were given although full return of neuromuscular activity in response to train-of -four and 100 Hz tetanic stimulation was observed after succinylcholin e. An overdose of clindamycin (2400 mg, instead of the intended 600 mg ) was given iv soon after the start of surgery. At the end of surgery, 75 min later, the patient made no attempt at spontaneous ventilation was unresponsive to painful stimuli and naloxone (0.2 mg iv) was ineff ective. Controlled ventilation was continued in the Recovery Room wher e neuromuscular testing showed a train-of-four ratio of 0.27 which imp roved to only 0.47 five minutes after calcium chloride (1.5 mg . kg(-1 ) iv), and to 0.62 after edrophonium (20 mg) and neostigmine (2 mg). N ine hours later the patient began to cough, the TOF had returned to 1. 0 and two hours later the trachea was extubated and spontaneous ventil ation was resumed. Large doses of clindamycin can induce profound, lon g-lasting neuromuscular blockade in the absence of non-depolarizing re laxants and after full recovery from succinylcholine has been demonstr ated.