POSTOPERATIVE REPARALYSIS AFTER ROCURONIUM FOLLOWING NEBULIZED EPINEPHRINE

Purpose: We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologica lly reversed with edrophonium after paralysis with rocuronium. Clinica l findings: A 12-yr-old girl developed postoperative reparalysis follo wing the intraoperative administration of rocuronium, A total of 0.92 mg . kg(-1) rocuronium was administered. After surgery; pharmacologica l reversal sal was achieved with 20 mg edrophonium with 0.15 mg. atrop ine sulfate iv 35 min after the last administration of rocuronium, Mus cular relaxation was monitored using an ulnar peripheral nerve stimula tor (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Wt were present. In the recovery room, following nebulized epine phrine, the patient became apneic. The patient was paralyzed and an ul nar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. Conclusion: Posto perative reparalysis following rocuronium may be a cause of postoperat ive respiratory distress. The definitive diagnosis is made using PNS a nd observing the response to pharmacological reversal. Nebulized epine phrine may have a previously undescribed role in the development of po stoperative reparalysis.